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General NPI Number Information
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NPI Number | 1619346582
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Entity Type | Organization
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Legal Business Name | LOVE, ANGELA M.
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 8816 FOOTHILL BLVD # 103-238
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7199
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Country | US
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Telephone | 909-231-8743
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Fax |
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Provider Business Mailing Address
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Address Line | 8816 FOOTHILL BLVD # 103-238
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7199
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Country | US
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Telephone | 909-231-8743
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. ANGELA M LOVE
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Credential | RMA,BS, MBA PARTIAL
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Telephone | 909-231-8743
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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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