Healthcare Provider Details

I. General information

NPI: 1528019882
Provider Name (Legal Business Name): NUCLEAR RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BARTON RD
GRAND TERRACE CA
92313-5015
US

IV. Provider business mailing address

22365 BARTON RD
GRAND TERRACE CA
92313-5078
US

V. Phone/Fax

Practice location:
  • Phone: 909-872-1157
  • Fax: 909-872-0989
Mailing address:
  • Phone: 909-872-1157
  • Fax: 909-872-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number5597-36
License Number StateCA

VIII. Authorized Official

Name: MS. MICHELLE PETTY
Title or Position: OFFICE MANAGER
Credential:
Phone: 909-872-1151