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General NPI Number Information
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NPI Number | 1508248527
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Entity Type | Organization
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Legal Business Name | INTERNIST LABORATORY
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 21018 OSBORNE ST SUITE 3
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City | CANOGA PARK
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State | CA
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Zip | 91304-1757
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Country | US
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Telephone | 562-906-5227
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Fax |
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Provider Business Mailing Address
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Address Line | 10200 PIONEER BLVD SUITE 500
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-6000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID MORGAN II
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Credential |
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Telephone | 562-906-5227
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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 | CLF4149
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License Number State | CA
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