SRK Clinic

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

Legal business name

SRK CLINIC

Practice address

10808 Foothill Blvd # 635
Rancho Cucamonga, CA 91730-3889

Phone

(626) 316-8915

NPI assigned

Apr 12, 2022

Last updated

Apr 12, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Staceey Key, CPT1

Title

Owner

Phone

(626) 316-8915

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1184366973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10808 FOOTHILL BLVD # 635",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10808 FOOTHILL BLVD # 635",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303889",
            "telephone_number": "626-316-8915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRK CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "KEY",
        "authorized_official_first_name": "STACEEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-316-8915",
        "authorized_official_credential": "CPT1"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Phlebotomy Technician in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Phlebotomy Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.