Organization
CCRMED INC
Active
Other names
central utah pathology
Organization subpart
No
Provider details
NPI number
Authorized official
LEON TAN QUE JR. M.D. (PRESIDENT)
(818) 924-0525
Entity
Organization
Contact information
Practice address
7301 MEDICAL CENTER DR, SUITE 200, WEST HILLS, CA 91307-1904
(818) 924-0525
(818) 936-0198
Mailing address
23705 VANOWEN ST, SUITE 151, WEST HILLS, CA 91307-3030
(818) 924-0525
(818) 936-0198
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
46D0992374
UT
Other
Enumeration date
12/09/2009
Last updated
08/10/2010
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