Provider Demographics
NPI:1144247867
Name:UNICARE LABORATORY, INC.
Entity type:Organization
Organization Name:UNICARE LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EULOGIO
Authorized Official - Middle Name:PATOLOT
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-588-2868
Mailing Address - Street 1:2835 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1818
Mailing Address - Country:US
Mailing Address - Phone:626-588-2868
Mailing Address - Fax:626-588-2486
Practice Address - Street 1:2835 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1818
Practice Address - Country:US
Practice Address - Phone:626-588-2868
Practice Address - Fax:626-588-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11387291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB32445FMedicaid