Organization
PVCH CLINICAL LABORATORY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID NASCA MD (PRESIDENT)
(909) 865-9824
Entity
Organization
Contact information
Practice address
1798 N. GAREY AVE, POMONA VALLEY, CA 91767-2918
(909) 865-9500
(419) 866-5453
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0091610
—
CA
01
—
ZZZ39226Z
BLUE SHIELD
—
Enumeration date
02/26/2007
Last updated
12/22/2022
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