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General NPI Number Information
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NPI Number | 1497792998
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Entity Type | Organization
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Legal Business Name | SEACLIFF DIAGNOSTICS MEDICAL GROUP, APC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2100 SATURN ST SUITE102
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City | MONTEREY PARK
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State | CA
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Zip | 91755-7437
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Country | US
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Telephone | 323-201-8200
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Fax | 323-201-8201
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Provider Business Mailing Address
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Address Line | 2100 SATURN ST SUITE102
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City | MONTEREY PARK
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State | CA
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Zip | 91755-7437
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Country | US
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Telephone | 323-201-8200
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Fax | 323-201-8201
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCY OAGN
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Credential |
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Telephone | 323-201-8200
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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 | CLF11688
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License Number State | CA
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