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General NPI Number Information
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NPI Number | 1265137905
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Entity Type | Organization
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Legal Business Name | LIFEQUEST DIAGNOSTIC, INC.
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 720 N VALLEY ST STE F
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City | ANAHEIM
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State | CA
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Zip | 92801-3830
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Country | US
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Telephone | 714-290-5440
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Fax | 855-844-9188
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Provider Business Mailing Address
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Address Line | 3595 INLAND EMPIRE BLVD BLDG 4 SUITE 200
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City | ONTARIO
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State | CA
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Zip | 91764-5920
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Country | US
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Telephone | 909-770-4403
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Fax | 855-844-9188
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER CEO
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Name | MRS. RODA L PADERNA
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Credential |
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Telephone | 714-290-5440
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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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