Ms Diagnostic Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF00341934 Issued in CA

Legal business name

MS DIAGNOSTIC LABORATORY LLC

Practice address

1928 E Center St
Anaheim, CA 92805-3408

Phone

(626) 840-2870

Fax

(626) 445-4612

NPI assigned

Jan 2, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Montano Deleon Geronimo Jr.

Title

Owner/Laboratory Manager

Phone

(626) 840-2870

Specialties & licenses 1

Addresses

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": "1325462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340755200000",
    "number": "1972873305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1928 E CENTER ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928053408",
            "telephone_number": "626-840-2870",
            "fax_number": "626-445-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1928 E CENTER ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928053408",
            "telephone_number": "626-840-2870",
            "fax_number": "626-445-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MS DIAGNOSTIC LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-02",
        "last_updated": "2012-06-27",
        "status": "A",
        "authorized_official_last_name": "GERONIMO",
        "authorized_official_first_name": "MONTANO",
        "authorized_official_middle_name": "DELEON",
        "authorized_official_title_or_position": "OWNER/LABORATORY MANAGER",
        "authorized_official_telephone_number": "626-840-2870",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF00341934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kurt Hugo Mueller, M.D.

• Clinical Medical Laboratory in Anaheim, CA
• Providers in Anaheim, 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 Jun 27, 2012; 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.