Organization
PURE DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON SHOEMAKER PHD (CEO)
(310) 795-4066
Entity
Organization
Contact information
Practice address
710 S BROOKHURST ST STE J, ANAHEIM, CA 92804-4321
(310) 795-4066
Mailing address
710 S BROOKHURST ST STE J, ANAHEIM, CA 92804-4321
(310) 795-4066
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
CLIA
CA
Enumeration date
06/02/2021
Last updated
06/02/2021
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