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General NPI Number Information
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NPI Number | 1558086108
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Entity Type | Organization
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Legal Business Name | UNIQUE MEDI TECH, LLC
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 20505 CRESCENT BAY DR
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City | LAKE FOREST
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State | CA
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Zip | 92630-8825
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Country | US
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Telephone | 949-317-0345
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Fax | 949-446-9141
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Provider Business Mailing Address
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Address Line | 20505 CRESCENT BAY DR
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City | LAKE FOREST
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State | CA
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Zip | 92630-8825
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Country | US
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Telephone | 949-317-0345
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Fax | 949-446-9141
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Authorized Official
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Title or Position | OWNER
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Name | RYAN HILTON
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Credential |
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Telephone | 305-332-0669
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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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