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General NPI Number Information
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NPI Number | 1366850901
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Entity Type | Organization
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Legal Business Name | MEDITEST LABORATORIES
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 17971 SKYPARK CIRCLE 33E
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City | IRVINE
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State | CA
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Zip | 92614-4394
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Country | US
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Telephone | 949-243-0205
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Fax | 888-242-0581
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Provider Business Mailing Address
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Address Line | 17971 SKYPARK CIRCLE 33E
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City | IRVINE
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State | CA
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Zip | 92614-4394
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Country | US
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Telephone | 949-243-0205
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Fax | 888-242-0581
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Authorized Official
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Title or Position | MANAGER
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Name | DANIEL HAMIC
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Credential |
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Telephone | 949-243-0205
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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 | 346204
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License Number State | CA
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