Medical Laboratory Services Medical Group, Inc.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC.

Practice address

36485 Inland Valley Dr
Wildomar, CA 92595-9681

Phone

(760) 731-3334

NPI assigned

Apr 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ernest N Holburt, MDNPI 1235193814

Title

President

Phone

(760) 731-3334

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Medical Laboratory Services Medical Group, Inc.

  • Clinical Medical Laboratory
  • Murrieta, CA
  • NPI 1639386964

  3173615036

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Medical Laboratory Services Medical Group Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1427011576

  O20080723000551

  Same enrollment

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ernest Holburt, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1235193814

  Cytopathology

  Medicare reassignment NPD Authorized official
• Stephen Dongjin Oh, D.O.

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1881867695
  Medicare reassignment NPD
• Mahnaz Shahidi-Asl, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Napa, CA
  • NPI 1801082201
  Medicare reassignment NPD
• Robert Veve, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1962466078

  Cytopathology

  Medicare reassignment NPD
• Duyet C Vo, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
  • NPI 1265496533

  Cytopathology

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1063477461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10076",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914100076",
            "telephone_number": "805-578-8300",
            "fax_number": "805-578-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36485 INLAND VALLEY DR",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925959681",
            "telephone_number": "760-731-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "HOLBURT",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-731-3334",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0092911",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer McCraner
• Michelle McDonald, RBT
• Tracy McGee, RBT
• Keisha R McLean
• Chloe McNeel
• Adrian Medina
• Debra Melgren
• Estela Mendiola
• Arlyn Mendoza
• Liliana Mendoza

• Anatomic Pathology & Clinical Pathology Physician in Wildomar, CA
• Providers in Wildomar, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.