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General NPI Number Information
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NPI Number | 1598568685
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Entity Type | Organization
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Legal Business Name | IMPERIAL CLINICAL & PATHOLOGY LAB LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 2026 N IMPERIAL AVE
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City | EL CENTRO
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State | CA
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Zip | 92243-1607
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Country | US
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Telephone | 760-592-4351
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Fax |
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Provider Business Mailing Address
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Address Line | 778 AGUA VISTA DR
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City | CHULA VISTA
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State | CA
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Zip | 91914-4302
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Country | US
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Telephone | 760-604-4233
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Fax | 619-934-4948
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Authorized Official
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Title or Position | MANAGER
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Name | DOUGLAS JUAREZ
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Credential | MD
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Telephone | 760-604-4233
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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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