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General NPI Number Information
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NPI Number | 1073903423
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Entity Type | Organization
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Legal Business Name | SAN DIEGO LABORATORY SOLUTIONS
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 4531 36TH ST
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City | SAN DIEGO
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State | CA
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Zip | 92116-3629
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Country | US
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Telephone | 858-397-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 3331 DICKENS ST
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City | SAN DIEGO
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State | CA
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Zip | 92106-2541
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JOHN BARRIENTEZ
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Credential |
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Telephone | 858-397-4773
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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 | 05D2087174
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License Number State | CA
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