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General NPI Number Information
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NPI Number | 1447486956
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Entity Type | Organization
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Legal Business Name | COGENT DIAGNOSTIC LABORATORIES, INC.
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 15326 CORNET ST
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-5532
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Country | US
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Telephone | 562-404-0626
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Fax |
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Provider Business Mailing Address
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Address Line | 941 CALLE NEGOCIO SUITE R
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6202
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Country | US
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Telephone | 949-369-9212
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Fax | 949-369-9220
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY D MCCULLUM
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Credential |
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Telephone | 818-333-7177
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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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