Spectrum Molecular Diagnostics Laboratory Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SPECTRUM MOLECULAR DIAGNOSTICS LABORATORY CORP

Practice address

30151 Avenida de Las Bandera Ste B
Rancho Santa Margarita, CA 92688-2170

Phone

(949) 264-6102

NPI assigned

Aug 16, 2021

Organization subpart

No

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

Authorized official

Name

Rick Ferguson

Title

President / Ceo

Phone

(714) 928-3162

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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

{
    "created_epoch": "1629072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1932874492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30151 AVENIDA DE LAS BANDERA",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882170",
            "telephone_number": "949-264-6102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30151 AVENIDA DE LAS BANDERA STE B",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882170",
            "telephone_number": "949-264-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM MOLECULAR DIAGNOSTICS LABORATORY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-16",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "714-928-3162"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2232585",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanner Bennett Smith, PT, DPT
• Julie Soria, NP
• Melany Soriano
• Ronald Leo Soriano
• Robert Karl Spang, PHYSICAL THERAPIST
• Jennifer Starkey, CCC-SLP
• Steven D Smith an Optometric Corporation
• Susan Stivers
• Sydney Stolz
• Michelle Lynn Storey, P.T.A.

• Clinical Medical Laboratory in Rancho Santa Margarita, CA
• Providers in Rancho Santa Margarita, 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 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.