Organization
SCADRF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN YARTER (CEO)
(949) 588-2190
Entity
Organization
Contact information
Practice address
5 HOLLAND STE 101, IRVINE, CA 92618-2568
(949) 588-2190
Mailing address
25332 PACIFICA AVE, MISSION VIEJO, CA 92691-3843
(949) 588-2190
(949) 588-2199
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
05D2065269
CA
291U00000X
Clinical Medical Laboratory
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2065269
CLIA
CA
Enumeration date
08/04/2014
Last updated
08/05/2014
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