Organization
CLEAN TESTING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEE HEILIGMAN (CEO)
(949) 430-7076
Entity
Organization
Contact information
Practice address
1650 ADAMS AVE, COSTA MESA, CA 92626-4958
(949) 430-7076
Mailing address
PO BOX 3211, NEWPORT BEACH, CA 92659-0855
(949) 430-7076
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D2051772
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2051772
CLIA ID
CA
Enumeration date
02/14/2013
Last updated
04/26/2016
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