Provider Demographics
NPI:1003810375
Name:SPECTRA LABORATORIES INC
Entity type:Organization
Organization Name:SPECTRA LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-526-3200
Mailing Address - Street 1:PO BOX 360790
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95036-0790
Mailing Address - Country:US
Mailing Address - Phone:408-526-3200
Mailing Address - Fax:408-526-3747
Practice Address - Street 1:525 SYCAMORE DRIVE
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7429
Practice Address - Country:US
Practice Address - Phone:408-526-3200
Practice Address - Fax:408-526-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF3259291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ59406ZMedicaid
CO98001761Medicaid
CT003099018Medicaid
FL090418000Medicaid
AZ067703Medicaid
AL000594060Medicaid
GA00305247AMedicaid
ID0034655Medicaid
DC0441970Medicaid
AK117941709Medicaid
ASLB259CAMedicaid