Healthcare Provider Details

I. General information

NPI: 1063881837
Provider Name (Legal Business Name): WEST COAST MED BILLING LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 UNIVERSITY AVE SUITE 543
SAN DIEGO CA
92104-2009
US

IV. Provider business mailing address

3245 UNIVERSITY AVE SUITE 543
SAN DIEGO CA
92104-2009
US

V. Phone/Fax

Practice location:
  • Phone: 619-255-7725
  • Fax: 619-255-7718
Mailing address:
  • Phone: 619-255-7725
  • Fax: 619-255-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number2015041531
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number2015041531
License Number StateCA

VIII. Authorized Official

Name: MR. PEDRO BOJORQUEZ
Title or Position: PRESIDENT
Credential:
Phone: 619-255-7725