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General NPI Number Information
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NPI Number | 1932874492
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Entity Type | Organization
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Legal Business Name | SPECTRUM MOLECULAR DIAGNOSTICS LABORATORY CORP
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 30151 AVENIDA DE LAS BANDERA STE B
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2170
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Country | US
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Telephone | 949-264-6102
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Fax |
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Provider Business Mailing Address
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Address Line | 30151 AVENIDA DE LAS BANDERA
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2170
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Country | US
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Telephone | 949-264-6102
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | RICK FERGUSON
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Credential |
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Telephone | 714-928-3162
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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 |
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License Number State |
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