Provider Demographics
NPI:1689921686
Name:SPECIALIZED MEDICAL, L.L.C.
Entity Type:Organization
Organization Name:SPECIALIZED MEDICAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-773-2633
Mailing Address - Street 1:34145 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE #700
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2808
Mailing Address - Country:US
Mailing Address - Phone:855-773-2633
Mailing Address - Fax:855-773-2633
Practice Address - Street 1:155 MEADOW LN
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5113
Practice Address - Country:US
Practice Address - Phone:855-773-2633
Practice Address - Fax:855-773-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory