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General NPI Number Information
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NPI Number | 1013281856
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEALTH ALLIANCE, LLC
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 23052 ALICIA PKWY # H495
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City | MISSION VIEJO
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State | CA
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Zip | 92692-1643
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Country | US
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Telephone | 949-233-5491
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Fax | 949-743-2377
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Provider Business Mailing Address
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Address Line | 23052 ALICIA PKWY # H495
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City | MISSION VIEJO
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State | CA
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Zip | 92692-1643
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Country | US
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Telephone | 949-233-5491
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Fax | 949-743-2377
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONALD LAZATIN
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Credential |
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Telephone | 949-233-5491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | CA
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