Healthcare Provider Details

I. General information

NPI: 1811367006
Provider Name (Legal Business Name): DIGESTIVE CARE LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAUREL ST
SAN CARLOS CA
94070-3939
US

IV. Provider business mailing address

1000 LAUREL ST
SAN CARLOS CA
94070-3939
US

V. Phone/Fax

Practice location:
  • Phone: 650-596-8800
  • Fax: 650-596-8802
Mailing address:
  • Phone: 650-596-8800
  • Fax: 650-596-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLA00329354
License Number StateCA

VIII. Authorized Official

Name: DR. SCOTT D LEVENSON
Title or Position: DIRECTOR
Credential: MD
Phone: 650-596-8800