Provider Demographics
NPI:1447598222
Name:REYMUNDO NOUR
Entity Type:Organization
Organization Name:REYMUNDO NOUR
Other - Org Name:MEDICAL LAB CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REYMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-600-5825
Mailing Address - Street 1:81626 US HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5413
Mailing Address - Country:US
Mailing Address - Phone:760-600-5825
Mailing Address - Fax:
Practice Address - Street 1:81626 US HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5413
Practice Address - Country:US
Practice Address - Phone:760-600-5825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLR00343403261Q00000X, 363L00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA119344Medicare PIN