Healthcare Provider Details

I. General information

NPI: 1467991307
Provider Name (Legal Business Name): LABORATORY MEDICINE CONSULTANTS IN DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 A MCGAW AVE
IRVINE CA
92614
US

IV. Provider business mailing address

1565 A MCGAW AVE
IRVINE CA
92614
US

V. Phone/Fax

Practice location:
  • Phone: 949-997-3611
  • Fax:
Mailing address:
  • Phone: 949-997-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberA86147
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207SM0001X
TaxonomyMolecular Genetic Pathology (Medical Genetics) Physician
License NumberA86147
License Number StateCA

VIII. Authorized Official

Name: DR. ARTHUR BACA
Title or Position: PRESIDENT
Credential: MD
Phone: 949-973-6112