Organization
MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST N HOLBURT MD (PRESIDENT)
(760) 731-3334
Entity
Organization
Contact information
Practice address
36485 INLAND VALLEY DR, WILDOMAR, CA 92595-9681
(760) 731-3334
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0092911
—
CA
Enumeration date
04/19/2006
Last updated
08/20/2009
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