Healthcare Provider Details

I. General information

NPI: 1629432109
Provider Name (Legal Business Name): CML LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15375 BARRANCA PKWY SUITE F-101
IRVINE CA
92618-2217
US

IV. Provider business mailing address

15375 BARRANCA PKWY SUITE F-101
IRVINE CA
92618-2217
US

V. Phone/Fax

Practice location:
  • Phone: 949-264-8904
  • Fax:
Mailing address:
  • Phone: 949-264-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0664072
License Number StateCA

VIII. Authorized Official

Name: MR. RONALD D FERGUSON
Title or Position: PRESIDNET & CEO
Credential:
Phone: 949-264-8904