Provider Demographics
NPI:1255726626
Name:CRESTVIEW CLINICAL LABORATORY LLC
Entity type:Organization
Organization Name:CRESTVIEW CLINICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-429-6607
Mailing Address - Street 1:5 HOLLAND #209
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2576
Mailing Address - Country:US
Mailing Address - Phone:877-429-6607
Mailing Address - Fax:562-888-8840
Practice Address - Street 1:5 HOLLAND #209
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2576
Practice Address - Country:US
Practice Address - Phone:562-210-6571
Practice Address - Fax:562-888-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory