Provider Demographics
NPI:1265137905
Name:LIFEQUEST DIAGNOSTIC, INC.
Entity type:Organization
Organization Name:LIFEQUEST DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RODA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PADERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-290-5440
Mailing Address - Street 1:3595 INLAND EMPIRE BLVD BLDG 4
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5920
Mailing Address - Country:US
Mailing Address - Phone:909-770-4403
Mailing Address - Fax:855-844-9188
Practice Address - Street 1:720 N VALLEY ST
Practice Address - Street 2:STE F
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3830
Practice Address - Country:US
Practice Address - Phone:714-290-5440
Practice Address - Fax:855-844-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory