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General NPI Number Information
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NPI Number | 1699363044
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CLIA CONSULTANT LLC
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 5805 CAPISTRANO AVE STE C
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City | ATASCADERO
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State | CA
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Zip | 93422-7218
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Country | US
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Telephone | 805-801-9997
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Fax |
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Provider Business Mailing Address
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Address Line | 5805 CAPISTRANO AVE STE C
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City | ATASCADERO
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State | CA
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Zip | 93422-7218
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Country | US
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Telephone | 805-801-9997
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Fax |
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Authorized Official
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Title or Position | CLS
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Name | MR. JASON D KENDALL
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Credential |
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Telephone | 805-801-9997
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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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