Central Medical Diagnostic Laboratory, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

CENTRAL MEDICAL DIAGNOSTIC LABORATORY, INC

Practice address

10554 Progress Way
Suite J
Cypress, CA 90630-4724

Phone

(888) 257-3873

Fax

(714) 821-1910

NPI assigned

Jun 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Chatfield Hiserodt, M.D.NPI 1235296864

Title

Ceo

Phone

(888) 257-3873

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Central Medical Laboratory Doing business as

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Chatfield Hiserodt, M.D.

  • Cytopathology Physician
  • Garden Grove, CA
  • NPI 1235296864
  NPD (past) Authorized official
• Praveena Yetur, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Glendora, CA
  • NPI 1043279490
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821025883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10554 PROGRESS WAY",
            "address_2": "SUITE J",
            "city": "CYPRESS",
            "state": "CA",
            "postal_code": "906304724",
            "telephone_number": "888-257-3873",
            "fax_number": "714-821-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10554 PROGRESS WAY",
            "address_2": "SUITE J",
            "city": "CYPRESS",
            "state": "CA",
            "postal_code": "906304724",
            "telephone_number": "888-257-3873",
            "fax_number": "714-821-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MEDICAL DIAGNOSTIC LABORATORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HISERODT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHATFIELD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-257-3873",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUM",
            "identifier": "ZZZ85259Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC# JOHN HISERODT MD",
            "identifier": "G77372",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB01869F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Medical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jo Anne Carpenter, PT
• Sonia A Cartagena, DDS
• Deborah Ann Cartwright
• Leslie A Castillo
• Krizha Castrence
• Central Medical Diagnostic Laboratory,Inc.
• Wendy Chaing
• Albert Jinli Chan, DDS
• Alex Chieh Chang Chan, DDS
• Angela Chan, DDS, MS

• All providers in Cypress, CA
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.