Organization
LEO NYHOLM
Active
Other names
Lab Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEO NYHOLM BIOANALYST (OWNER)
(661) 822-1965
Entity
Organization
Contact information
Practice address
20825 SOUTH ST, SUITE D, TEHACHAPI, CA 93561-8649
(661) 822-1965
(661) 823-1971
Mailing address
20825 SOUTH ST, SUITE D, TEHACHAPI, CA 93561-8649
(661) 822-1965
(661) 823-1971
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 11592
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0962446
CLIA NUMBER
CA
01
—
CLF11592
LABORATORY LICENSE NUMBER
CA
01
—
ZZZ17938Z
MEDICARE PTAN
CA
Enumeration date
03/09/2007
Last updated
06/18/2008
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