Healthcare Provider Details

I. General information

NPI: 1487243499
Provider Name (Legal Business Name): PRECISION DIAGNOSTIC LABORATORIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 ENCHANTED
IRVINE CA
92620-2807
US

IV. Provider business mailing address

41 ENCHANTED
IRVINE CA
92620-2807
US

V. Phone/Fax

Practice location:
  • Phone: 949-231-7193
  • Fax:
Mailing address:
  • Phone: 949-231-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. URSULA SJOROOS
Title or Position: PRESIDENT
Credential:
Phone: 949-231-7193