Organization
MEDICAL DIAGNOSTIC LABORATORY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FAUSTO MENDEZ JR. (MANAGING MEMBER)
(626) 303-8674
Entity
Organization
Contact information
Practice address
1330 ARROW HWY, LA VERNE, CA 91750-5218
(626) 303-8674
(626) 256-9098
Mailing address
PO BOX 7938, LA VERNE, CA 91750-7938
(626) 303-8674
(626) 256-9098
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
05D0642547
CA
291U00000X
Clinical Medical Laboratory
Primary
CLF1817
CA
Other
Enumeration date
12/12/2008
Last updated
10/08/2013
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