MEDICARE: HUNTINGTON BEACH CLINICAL LABORATORY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	05D1080532	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CLF 334485	OTHER	CA	CLINICAL LABORATORY LICENSE

General Provider Information

NPI Number	:	1093045825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTINGTON BEACH CLINICAL LABORATORY INC

Provider Business Mailing Address
First Line	:	8071 SLATER AVE
Second Line	:	STE 100
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6960
Country	:	US
Telephone Number	:	714-843-9600
Fax Number	:	714-717-4230

Provider Business Practice Location Address
First Line	:	8071 SLATER AVE
Second Line	:	STE 100
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6960
Country	:	US
Telephone Number	:	714-843-9600
Fax Number	:	714-717-4230

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIRILL A VOYLOSHNIKOV
Credential	:
Telephone Number	:	714-843-9600

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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