Omni Diagnostic Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

OMNI DIAGNOSTIC LABORATORY LLC

Practice address

1888 W 6TH St Ste H
Corona, CA 92882-2993

Phone

(714) 493-1224

Fax

(951) 547-4416

NPI assigned

Feb 16, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Ahsan Baseer

Title

Ceo

Phone

(714) 493-1224

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1124773304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1888 W 6TH ST STE H",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928822993",
            "telephone_number": "714-493-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1888 W 6TH ST STE H",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928822993",
            "telephone_number": "714-493-1224",
            "fax_number": "951-547-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI DIAGNOSTIC LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "BASEER",
        "authorized_official_first_name": "AHSAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-493-1224",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CLIA ID",
            "identifier": "05D2128426",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABORATORY LICENSE",
            "identifier": "CLM-00350523",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "OMNILABLLC",
            "affiliation": "N",
            "endpointDescription": "LABORATORY INFOMATION SYSTEM",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "useOtherDescription": "PATIENT REPORT ACCESS",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Communications",
            "address_1": "1888 W 6th St Ste H",
            "city": "Corona",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928822993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Medical Laboratory in Corona, CA
• Providers in Corona, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.