Internist Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF4149 Issued in CA

Legal business name

INTERNIST LABORATORY

Practice address

21018 Osborne St
Suite 3
Canoga Park, CA 91304-1757

Phone

(562) 906-5227

NPI assigned

Jun 25, 2015

Last updated

Jan 19, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

INTERNIST LABORATORY - CANOGAAs reported in NPPES

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

Authorized official

Name

David Morgan II

Title

Ceo

Phone

(562) 906-5227

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Internist Lab Med GRP

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453161600000",
    "number": "1508248527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 PIONEER BLVD",
            "address_2": "SUITE 500",
            "city": "SANTA FE SPRINGS",
            "state": "CA",
            "postal_code": "906706000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21018 OSBORNE ST",
            "address_2": "SUITE 3",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913041757",
            "telephone_number": "562-906-5227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNIST LABORATORY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERNIST LABORATORY - CANOGA",
        "enumeration_date": "2015-06-25",
        "last_updated": "2016-01-19",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-906-5227",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF4149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0696979",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Canoga Park, CA
• Providers in Canoga Park, 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 Jan 19, 2016; 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.