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General NPI Number Information
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NPI Number | 1255726626
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Entity Type | Organization
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Legal Business Name | CRESTVIEW CLINICAL LABORATORY LLC
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 5 HOLLAND #209
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City | IRVINE
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State | CA
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Zip | 92618-2576
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Country | US
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Telephone | 562-210-6571
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Fax | 562-888-8262
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Provider Business Mailing Address
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Address Line | 5 HOLLAND #209
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City | IRVINE
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State | CA
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Zip | 92618-2576
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Country | US
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Telephone | 877-429-6607
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Fax | 562-888-8840
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUSTIN NGUYEN
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Credential |
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Telephone | 877-429-6607
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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 |
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License Number State |
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