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General NPI Number Information
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NPI Number | 1992866263
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Entity Type | Organization
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Legal Business Name | CENTRAL REFERENCE LABORATORY INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 1470 S.VALLEY VISTA DR 100
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3903
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Country | US
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Telephone | 909-861-6966
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Fax | 909-860-6396
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Provider Business Mailing Address
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Address Line | 1470 S.VALLEY VISTA DR 100
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3903
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Country | US
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Telephone | 909-861-6966
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Fax | 909-860-6396
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Authorized Official
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Title or Position | CEO
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Name | MR. ABBAS RAJAEE
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Credential | M.SC.,J.D.
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Telephone | 90908616966
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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 | CLF4032
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License Number State | CA
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