=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881699346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUZ MOR DIAGNOSTIC LAB INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 W MANCHESTER BLVD
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90305-2436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-758-5161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 W MANCHESTER BLVD
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90305-2436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-758-5161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOE L MOREHEAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-971-0635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | CLF3216
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------