Crestview Clinical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

05D0930808 Issued in CA

Legal business name

CRESTVIEW CLINICAL LABORATORY

Practice address

460 W Putnam Ave
Porterville, CA 93257-3321

Phone

(559) 781-6975

Fax

(559) 783-2084

NPI assigned

Jul 11, 2006

Last updated

Oct 17, 2008By 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

Roy Berglund, M.D.

Title

Medical Director

Phone

(559) 781-6975

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224201600000",
    "number": "1750315008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 W PUTNAM AVE",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932573321",
            "telephone_number": "559-781-6975",
            "fax_number": "559-783-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 W PUTNAM AVE",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932573321",
            "telephone_number": "559-781-6975",
            "fax_number": "559-783-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW CLINICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2008-10-17",
        "status": "A",
        "authorized_official_last_name": "BERGLUND",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "559-781-6975",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D0930808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB30808F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• County of Tulare (Porterville Youth Mental Health Services)
• County of Tulare Health and Human Services Agency (CCS Porterville Mtu)
• Paula Kay Cowdrey, RD
• Dale Jackson Cox, M.D.
• Joseph Wayne Cox, B.A.
• Francis Dizon Cunanan, M.D.
• Maria Emilia Perez Cunanan, M.D.
• Aaron Scott Currie, PHYSICIAN ASSISTANT
• CVPT Corporation (SmithCare Therapy Center)
• Kathleen Daguman

• Clinical Medical Laboratory in Porterville, CA
• Providers in Porterville, 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 Oct 17, 2008; 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.