=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205362522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PMH LABORATORY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2017
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17791 FITCH
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92614-6019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-360-6668
-----------------------------------------------------
Fax | 909-803-9790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17791 FITCH
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92614-6019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-360-6668
-----------------------------------------------------
Fax | 909-803-9790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. DESIREE MONIQUE HEDGE
-----------------------------------------------------
Credential | CLS
-----------------------------------------------------
Telephone | 562-592-2890
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------