# PVCH CLINICAL LABORATORY MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235265851
- **Authorized official:** DR. DAVID NASCA MD (PRESIDENT)
- **Authorized official phone:** (909) 865-9824

## Contact information

- **Practice address:** 1798 N. GAREY AVE, POMONA VALLEY, CA 91767-2918
- **Practice address phone:** (909) 865-9500
- **Practice address fax:** (419) 866-5453
- **Mailing address:** 5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
- **Mailing address phone:** (800) 288-8325
- **Mailing address fax:** (419) 866-5453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2007
- **Last updated:** 12/22/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0091610 | — | CA |
| 01 | — | ZZZ39226Z | BLUE SHIELD | — |