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General NPI Number Information
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NPI Number | 1013578517
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Entity Type | Organization
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Legal Business Name | CONCENTRIC DIAGNOSTICS LLC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 3030 BUNKER HILL ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-5754
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Country | US
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Telephone | 619-838-7908
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 EMERALD BAY
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-1234
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Country | US
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Telephone | 619-838-7908
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JASON HANSEN
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Credential |
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Telephone | 619-838-7908
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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 |
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