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Organization
PVCH CLINICAL LABORATORY MEDICAL GROUP INC
Active
Organization
PVCH CLINICAL LABORATORY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID NASCA MD (PRESIDENT)
(909) 865-9824
Entity
Organization
Contact information
Practice address
1798 N. GAREY AVE, POMONA VALLEY, CA 91767-2918
(909) 865-9500
(419) 866-5453
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0091610
—
CA
01
—
ZZZ39226Z
BLUE SHIELD
—
Enumeration date
02/26/2007
Last updated
12/22/2022
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