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General NPI Number Information
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NPI Number | 1417238361
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED BIOPHARMA SOLUTIONS, INC
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 1920 RIVERVIEW DR SUITE 340
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3003
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Country | US
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Telephone | 800-487-9036
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Fax | 909-748-5012
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Provider Business Mailing Address
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Address Line | 25612 BARTON RD SUITE 340
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City | LOMA LINDA
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State | CA
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Zip | 92354-3110
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Country | US
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Telephone | 800-487-9036
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Fax | 909-748-5012
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Authorized Official
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Title or Position | VICE PRESIDENT/ LAB ADMINISTRATOR
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Name | DR. JOSEPH W WEKESA
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Credential | PH.D.
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Telephone | 800-487-9036
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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 | CLS339518
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License Number State | CA
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