Provider Demographics
NPI:1093392458
Name:CLEANQUEST LLC
Entity Type:Organization
Organization Name:CLEANQUEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-340-4690
Mailing Address - Street 1:17952 SKY PARK CIR STE K
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4416
Mailing Address - Country:US
Mailing Address - Phone:714-340-4690
Mailing Address - Fax:
Practice Address - Street 1:424 E HOSPITALITY LN STE B3
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3567
Practice Address - Country:US
Practice Address - Phone:714-340-4690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEANQUEST LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory