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General NPI Number Information
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NPI Number | 1760872048
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Entity Type | Organization
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Legal Business Name | OMNIBUS CLINICAL RESEARCH
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 5471 LA PALMA AVE STE 200
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City | LA PALMA
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State | CA
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Zip | 90623-4702
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Country | US
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Telephone | 714-828-9888
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Fax | 714-828-4888
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Provider Business Mailing Address
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Address Line | 5471 LA PALMA AVE STE 200
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City | LA PALMA
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State | CA
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Zip | 90623-4702
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Country | US
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Telephone | 714-828-9888
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Fax | 714-828-4888
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VIOLET LUISZER
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Credential |
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Telephone | 714-828-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A41795
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License Number State | CA
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