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General NPI Number Information
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NPI Number | 1235214198
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Entity Type | Organization
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Legal Business Name | REGENT MEDICAL GROUP LABORATORY
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 644 E REGENT ST SUITE 200
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City | INGLEWOOD
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State | CA
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Zip | 90301-1433
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Country | US
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Telephone | 310-674-5353
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Fax | 310-674-7041
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Provider Business Mailing Address
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Address Line | 644 E REGENT ST SUITE 200
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City | INGLEWOOD
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State | CA
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Zip | 90301-1433
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Country | US
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Telephone | 310-674-5353
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Fax | 310-674-7041
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. RANDY W HAWKINS
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Credential | M.D.
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Telephone | 310-674-5353
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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 | CLA312840
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License Number State | CA
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