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General NPI Number Information
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NPI Number | 1386788594
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Entity Type | Organization
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Legal Business Name | IMPERIAL CLINICAL LABORATORY INC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 7291 HEIL AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-0000
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Country | US
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Telephone | 714-375-0800
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Fax | 714-375-0814
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Provider Business Mailing Address
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Address Line | 7291 HEIL AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-4467
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Country | US
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Telephone | 714-375-0800
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Fax | 714-375-0814
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LUKE WATSON
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Credential | M.D.
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Telephone | 714-375-0800
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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 | CLF 10598
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License Number State | CA
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