Organization
VINOD C. PATWARDHAN MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINOD C PATWARDHAN MD (OWNER/DIRECTOR)
(909) 949-4435
Entity
Organization
Contact information
Practice address
918 W FOOTHILL BLVD, SUITE B, UPLAND, CA 91786-3772
(909) 949-4435
(909) 982-4436
Mailing address
918 W FOOTHILL BLVD, SUITE B, UPLAND, CA 91786-3772
(909) 949-4435
(909) 982-4436
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
LAB64832F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0564832
CLIA ID
CA
01
—
CLM00302177
CLINICAL LABORATORY LICENSE
CA
05
—
LAB64832F
—
CA
Enumeration date
01/26/2012
Last updated
01/26/2012
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