Provider Demographics
NPI:1477786291
Name:THOMAS G HIROSE, M.D. APC LABORATORY
Entity Type:Organization
Organization Name:THOMAS G HIROSE, M.D. APC LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:HIROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:949-487-5100
Mailing Address - Street 1:647 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 223
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2807
Mailing Address - Country:US
Mailing Address - Phone:949-487-5100
Mailing Address - Fax:949-487-7065
Practice Address - Street 1:647 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 223
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2807
Practice Address - Country:US
Practice Address - Phone:949-487-5100
Practice Address - Fax:949-487-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66676291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory