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General NPI Number Information
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NPI Number | 1316117781
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Entity Type | Organization
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Legal Business Name | CAREONE LABORATORY, LLC
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Dates
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Enumeration Date | 03/02/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 12980 FREDERICK ST SUITE D
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5263
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Country | US
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Telephone | 951-243-2600
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Fax | 951-243-6654
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Provider Business Mailing Address
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Address Line | PO BOX 8227
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City | MORENO VALLEY
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State | CA
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Zip | 92552-8227
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Country | US
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Telephone | 951-243-2600
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Fax | 951-243-6654
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. ANTONIO A. TAN
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Credential | M.D.
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Telephone | 951-243-2600
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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 | CA
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