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General NPI Number Information
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NPI Number | 1023081098
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Entity Type | Organization
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Legal Business Name | MONTE VISTA MEDICAL LABORATORY, INC.
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 945 SAINT JOHN PL
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City | HEMET
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State | CA
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Zip | 92543-4421
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Country | US
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Telephone | 951-652-4409
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Fax | 951-929-1443
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Provider Business Mailing Address
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Address Line | 945 SAINT JOHN PL
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City | HEMET
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State | CA
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Zip | 92543-4421
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Country | US
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Telephone | 951-652-4409
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Fax | 951-929-1443
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Authorized Official
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Title or Position | SEC/TREAS
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Name | NANCY DEE CORDILL
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Credential | C.L.S.
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Telephone | 951-652-4409
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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 | CLF 3417
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License Number State | CA
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