NPIMap

Organization Active NPI

Crestview Clinical Laboratory

  • Clinical Medical Laboratory
  • Rialto, CA
National Provider Identifier
1154557213
Registry record updated Jun 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
CLF 11381 Issued in CA
Legal business name
CRESTVIEW CLINICAL LABORATORY
Practice address
1471 S Riverside Ave
Rialto, CA 92376-7703
Phone
(909) 877-1361
Fax
(909) 877-0854
NPI assigned
Jun 3, 2009
Organization subpart
Yes
Parent organization
CRESTVIEW CONVALESCENT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2009

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

Authorized official

Name
Mrs. Leona June Berglund
Title
Administrator
Phone
(909) 877-1361

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X CLF 11381 CA Primary

Addresses

Primary practice location

1471 S Riverside Ave
Rialto, CA 92376-7703

Mailing address

1471 S Riverside Ave
Rialto, CA 92376-7703
Phone (909) 877-1361

National Provider Directory

National Provider Directory
Tax ID family
Crestview Convalescent Hospital3 organizations share this tax ID, including this one
Part of
Crestview Convalescent Hospital

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243987200000",
    "number": "1154557213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1471 S RIVERSIDE AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923767703",
            "telephone_number": "909-877-1361",
            "fax_number": "909-877-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1471 S RIVERSIDE AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923767703",
            "telephone_number": "909-877-1361",
            "fax_number": "909-877-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW CLINICAL LABORATORY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRESTVIEW CONVALESCENT HOSPITAL",
        "enumeration_date": "2009-06-03",
        "last_updated": "2009-06-03",
        "status": "A",
        "authorized_official_last_name": "BERGLUND",
        "authorized_official_first_name": "LEONA",
        "authorized_official_middle_name": "JUNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "909-877-1361",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF 11381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rialto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2009; 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.