Prime Clinical Laboratory Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PRIME CLINICAL LABORATORY INC.

Practice address

72650 Fred Waring Dr
Palm Desert, CA 92260-5006

Phone

(661) 253-1173

NPI assigned

Dec 30, 2016

Organization subpart

No

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

Authorized official

Name

Jose Bragasin

Title

Owner

Phone

(661) 253-1173

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1483056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659657600000",
    "number": "1871038778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27825 FREMONT CT STE 14",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913551143",
            "telephone_number": "661-253-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72650 FRED WARING DR",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922605006",
            "telephone_number": "661-253-1173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27825 Fremont Ct Ste 14",
            "address_purpose": "LOCATION",
            "city": "Valencia",
            "state": "CA",
            "postal_code": "913551143",
            "country_code": "US",
            "telephone_number": "661-253-1173",
            "fax_number": "661-253-1174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIME CLINICAL LABORATORY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-30",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "BRAGASIN",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "661-253-1173"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Palm Desert, CA
• Providers in Palm Desert, 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 Aug 5, 2022; 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.