Provider Demographics
NPI:1942608195
Name:ADVANCED DIAGNOSTICS LAB LLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTICS LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CQRM
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-274-8355
Mailing Address - Street 1:23275 S POINTE DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-274-8355
Mailing Address - Fax:949-258-5076
Practice Address - Street 1:23275 S POINTE DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-274-8355
Practice Address - Fax:949-258-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2087903291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory