Provider Demographics
NPI:1518173178
Name:FULL SPECTRUM DIAGNOSTICS
Entity Type:Organization
Organization Name:FULL SPECTRUM DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-833-2289
Mailing Address - Street 1:92 CORPORATE PARK STE C750
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:92 CORPORATE PARK STE C750
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5146
Practice Address - Country:US
Practice Address - Phone:949-833-2289
Practice Address - Fax:949-251-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory