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General NPI Number Information
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NPI Number | 1811367006
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Entity Type | Organization
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Legal Business Name | DIGESTIVE CARE LABORATORY
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 1000 LAUREL ST
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City | SAN CARLOS
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State | CA
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Zip | 94070-3939
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Country | US
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Telephone | 650-596-8800
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Fax | 650-596-8802
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Provider Business Mailing Address
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Address Line | 1000 LAUREL ST
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City | SAN CARLOS
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State | CA
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Zip | 94070-3939
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Country | US
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Telephone | 650-596-8800
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Fax | 650-596-8802
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SCOTT D LEVENSON
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Credential | MD
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Telephone | 650-596-8800
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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 | CLA00329354
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License Number State | CA
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