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General NPI Number Information
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NPI Number | 1639753270
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Entity Type | Organization
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Legal Business Name | PENINSULA HEIGHTS DIAGNOSTIC LABORATORIES, INC.
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 1720 EL CAMINO REAL STE 110
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City | BURLINGAME
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State | CA
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Zip | 94010-3224
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Country | US
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Telephone | 408-332-2748
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 EL CAMINO REAL STE 110
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City | BURLINGAME
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State | CA
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Zip | 94010-3211
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Country | US
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Telephone | 650-977-0449
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | VICHKY HOANG
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Credential |
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Telephone | 925-579-1579
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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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