Organization
CRESTVIEW CLINICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONA BERGLUND (ADMINISTRATOR)
(909) 877-1361
Entity
Organization
Contact information
Practice address
1471 S RIVERSIDE AVE, RIALTO, CA 92376-7703
(909) 877-1361
Mailing address
1471 S RIVERSIDE AVE, RIALTO, CA 92376-7703
(909) 877-1361
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LAB64416F
PIN NUMBER
CA
Enumeration date
08/11/2006
Last updated
08/22/2020
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