Organization
INTERNIST LABORATORY
Active
Organization
INTERNIST LABORATORY
Active
Other names
VantagePoint Laboratory Partners
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD E. NICHOLSON (CEO)
(562) 906-5227
Entity
Organization
Contact information
Practice address
10200 PIONEER BLVD, SUITE 500, SANTA FE SPRINGS, CA 90670-6000
(562) 906-5227
(562) 906-6450
Mailing address
4980 CARROLL CANYON RD, SAN DIEGO, CA 92121-1736
(858) 638-8120
(858) 638-8298
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 2678
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0643041
CLIA
—
Enumeration date
10/04/2006
Last updated
08/06/2012
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