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General NPI Number Information
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NPI Number | 1972873305
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Entity Type | Organization
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Legal Business Name | MS DIAGNOSTIC LABORATORY LLC
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Dates
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Enumeration Date | 01/02/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 1928 E CENTER ST
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City | ANAHEIM
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State | CA
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Zip | 92805-3408
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Country | US
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Telephone | 626-840-2870
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Fax | 626-445-4612
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Provider Business Mailing Address
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Address Line | 1928 E CENTER ST
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City | ANAHEIM
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State | CA
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Zip | 92805-3408
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Country | US
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Telephone | 626-840-2870
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Fax | 626-445-4612
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Authorized Official
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Title or Position | OWNER/LABORATORY MANAGER
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Name | MR. MONTANO DELEON GERONIMO JR.
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Credential |
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Telephone | 626-840-2870
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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 | CLF00341934
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License Number State | CA
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