Provider Demographics
NPI:1568555134
Name:AMERICAN CLINICAL REFERENCE LABORATORY INC.
Entity Type:Organization
Organization Name:AMERICAN CLINICAL REFERENCE LABORATORY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:ATOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-444-0707
Mailing Address - Street 1:701 BREA CANYON RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3036
Mailing Address - Country:US
Mailing Address - Phone:909-444-0707
Mailing Address - Fax:909-444-0710
Practice Address - Street 1:701 BREA CANYON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-3036
Practice Address - Country:US
Practice Address - Phone:909-444-0707
Practice Address - Fax:909-444-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11197291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7708029OtherMEDICAL PIN NUMBER
CALAB15253F3Medicaid
CALAB15253F3Medicaid