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Organization

GORDON M RICK

Active
Other names
Scripps Oral Pathology Service
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GORDON MARVIN RICK DDS (OWNER/DIRECTOR)
(858) 784-0600
Entity
Organization

Contact information

Practice address
5190 GOVERNOR DR, SUITE 106, SAN DIEGO, CA 92122-2847
(858) 784-0600
(858) 784-0604
Mailing address
5190 GOVERNOR DR, SUITE 106, SAN DIEGO, CA 92122-2847
(858) 784-0600
(858) 784-0604

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF11078
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LAB43007F
CA
Enumeration date
03/14/2008
Last updated
06/03/2013
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