Provider Demographics
NPI:1417238361
Name:DIVERSIFIED BIOPHARMA SOLUTIONS, INC
Entity Type:Organization
Organization Name:DIVERSIFIED BIOPHARMA SOLUTIONS, INC
Other - Org Name:DIVERSIFIED CLINICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/ LAB ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEKESA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:800-487-9036
Mailing Address - Street 1:25612 BARTON RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3110
Mailing Address - Country:US
Mailing Address - Phone:800-487-9036
Mailing Address - Fax:909-748-5012
Practice Address - Street 1:1920 RIVERVIEW DR
Practice Address - Street 2:SUITE 340
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3003
Practice Address - Country:US
Practice Address - Phone:800-487-9036
Practice Address - Fax:909-748-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLS339518291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory