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General NPI Number Information
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NPI Number | 1215166939
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Entity Type | Organization
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Legal Business Name | SOUTH COAST CLINICAL LABORATORIES
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 15326 CORNET ST
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-5532
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Country | US
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Telephone | 310-387-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 5 MIDNIGHT LN
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City | DANA POINT
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State | CA
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Zip | 92629-5905
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Country | US
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Telephone | 310-387-8700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT D SUER
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Credential |
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Telephone | 310-387-8700
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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 10499
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License Number State | CA
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