Provider Demographics
NPI:1184615676
Name:WESTCLIFF MEDICAL LABORATORIES INC
Entity type:Organization
Organization Name:WESTCLIFF MEDICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-724-3900
Mailing Address - Street 1:1821 E DYER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5700
Mailing Address - Country:US
Mailing Address - Phone:949-724-3900
Mailing Address - Fax:949-222-3430
Practice Address - Street 1:1821 E DYER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5700
Practice Address - Country:US
Practice Address - Phone:949-724-3900
Practice Address - Fax:949-222-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 2611291U00000X
CACLF 11317291U00000X
CACLF 11008291U00000X
CACLF 11683291U00000X
CACLF 11742291U00000X
CACLF 10791291U00000X
CACLF 11235291U00000X
CACLF 11532291U00000X
CACLF 1741291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB 71140 FMedicaid
CALAB 78685 FMedicaid
CALAB 25263 GMedicaid
CALAB 86102 FMedicaid
CALAB 89205 GMedicaid
CA05D0955508Medicare UPIN
CA05D0925263Medicare UPIN
CALAB 71140 FMedicaid
CALAB 25263 GMedicaid
CA05D0686102Medicare UPIN
CALAB 78685 FMedicaid
CAZZZ13536ZMedicare PIN