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General NPI Number Information
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NPI Number | 1710919303
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST CLINICAL LABORATORY, INC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 350 POSADA LN SUITE 100
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City | TEMPLETON
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State | CA
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Zip | 93465-4059
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Country | US
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Telephone | 805-434-9080
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Fax | 805-434-9082
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Provider Business Mailing Address
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Address Line | 350 POSADA LN SUITE 100
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City | TEMPLETON
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State | CA
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Zip | 93465-4059
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Country | US
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Telephone | 805-434-9080
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Fax | 805-434-9082
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RONA GRIFFIN
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Credential | MTASCP
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Telephone | 805-434-9080
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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 | CLF11785
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License Number State | CA
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