Organization
LABORATORY DIAGNOSTICS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN CARLSON MD (PRESIDENT)
(858) 626-6000
Entity
Organization
Contact information
Practice address
9888 GENESEE AVE, LA JOLLA, CA 92037-1276
(858) 626-6000
(419) 866-5453
Mailing address
1801 W OLYMPIC BLVD, #1016, PASADENA, CA 91199-0001
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
05D0663110
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR00086691
—
CA
Enumeration date
06/27/2006
Last updated
01/11/2016
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