Provider Demographics
NPI:1710382734
Name:SPRINT DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SPRINT DIAGNOSTICS LLC
Other - Org Name:SPRINT DIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-338-4908
Mailing Address - Street 1:1820 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5503
Mailing Address - Country:US
Mailing Address - Phone:949-222-0680
Mailing Address - Fax:949-222-0679
Practice Address - Street 1:1820 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5503
Practice Address - Country:US
Practice Address - Phone:949-222-0680
Practice Address - Fax:949-222-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 00339427291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2003251OtherCLIA