Spectra Clinical Laboratories, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF 10042 Issued in CA

Legal business name

SPECTRA CLINICAL LABORATORIES, INC

Practice address

5160 Campus Dr
Newport Beach, CA 92660-2101

Phone

(562) 776-8440

Fax

(562) 776-8070

NPI assigned

Aug 16, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ryan L Quimby-Johnson

Title

President and Ceo

Phone

(949) 545-8738

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SPECTRA CLINICAL LABORATORIES. Other name

Locations

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1679686646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 755",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902770755",
            "telephone_number": "562-776-8440",
            "fax_number": "562-776-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5160 CAMPUS DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602101",
            "telephone_number": "562-776-8440",
            "fax_number": "562-776-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRA CLINICAL LABORATORIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "QUIMBY-JOHNSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "949-545-8738",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF 10042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN #",
            "identifier": "X558836",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB58836F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPECTRA CLINICAL LABORATORIES.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SPECTRA CLINICAL LABORATORIES.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Charles Robert Spicer, M.S., M.B.A.

• Clinical Medical Laboratory in Newport Beach, CA
• Providers in Newport Beach, 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 Sep 28, 2023; 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.