Provider Demographics
NPI:1003155896
Name:CLEAN TESTING SERVICES
Entity Type:Organization
Organization Name:CLEAN TESTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEILIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-430-7076
Mailing Address - Street 1:PO BOX 3211
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0855
Mailing Address - Country:US
Mailing Address - Phone:949-430-7076
Mailing Address - Fax:
Practice Address - Street 1:1650 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4958
Practice Address - Country:US
Practice Address - Phone:949-430-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2051772291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2051772OtherCLIA ID