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General NPI Number Information
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NPI Number | 1639386964
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Entity Type | Organization
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Legal Business Name | MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 40663 MURRIETA HOT SPRINGS RD STE C1
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City | MURRIETA
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State | CA
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Zip | 92562-9015
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Country | US
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Telephone | 951-834-9020
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Fax | 951-834-9026
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Provider Business Mailing Address
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Address Line | PO BOX 2740
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City | FALLBROOK
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State | CA
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Zip | 92088-2740
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Country | US
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Telephone | 805-250-9233
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Fax | 805-578-3911
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Authorized Official
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Title or Position | CEO
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Name | ERNEST HOLBURT
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Credential |
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Telephone | 951-834-9020
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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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