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General NPI Number Information
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NPI Number | 1750630885
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Entity Type | Organization
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Legal Business Name | PROOVE MEDICAL LABORATORIES, INC.
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 26 TECHNOLOGY DR. EAST
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City | IRVINE
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State | CA
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Zip | 92618-2380
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Country | US
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Telephone | 855-776-6832
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Fax | 888-233-6857
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Provider Business Mailing Address
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Address Line | 15326 ALTON PKWY
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City | IRVINE
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State | CA
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Zip | 92618-2338
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Country | US
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Telephone | 855-776-6832
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Fax | 888-233-6857
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Authorized Official
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Title or Position | CEO
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Name | MR. BRIAN J. MESHKIN
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Credential |
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Telephone | 855-776-6832
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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 | GO12076
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License Number State | CA
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Taxonomy #2
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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 | CA
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