California Stat Laboratories

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF 347539 Issued in CA

Legal business name

CALIFORNIA STAT LABORATORIES

Doing business as

IndiviDx

Practice address

1350 Foothill Blvd
La Verne, CA 91750-3332

Phone

(909) 219-4131

Fax

(909) 512-6492

NPI assigned

Apr 29, 2015

Last updated

Feb 23, 2018By 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

Mr. Kurt Jose, MSC

Title

President/Ceo

Phone

(909) 809-1494

Specialties & licenses 1

Addresses

Other names 1

• IndiviDx Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Afshin Kaivan-Mehr, D.C

  • Chiropractor
  • La Verne, CA
  • NPI 1205032653
  NPD (past)
• Marissa Danielle Serna, DC

  • Chiropractor
  • La Verne, CA
  • NPI 1588386007
  NPD (past)

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519344000000",
    "number": "1427435361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917500638",
            "telephone_number": "909-219-4131",
            "fax_number": "909-512-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 FOOTHILL BLVD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503332",
            "telephone_number": "909-219-4131",
            "fax_number": "909-512-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA STAT LABORATORIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "last_updated": "2018-02-23",
        "status": "A",
        "authorized_official_last_name": "JOSE",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "909-809-1494",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSC"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF 347539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IndiviDx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Burkhart, D.C.
• Jacqueline Bustos
• Calvena Monique Butler
• C&L Medical Group Inc.
• Jennifer Hulsha Cabanas
• Calm Path Psychological Services, Inc.
• Gricel Calzada
• Dayannara Campos Medina, OTD
• Angie Canales, H.S.
• Beatriz Canales

• Clinical Medical Laboratory in La Verne, CA
• Providers in La Verne, 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 23, 2018; 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.