Organization
MEDICAL LABORATORY SERVICES MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST HOLBURT MD (PRESIDENT)
(760) 731-3334
Entity
Organization
Contact information
Practice address
25500 MEDICAL CENTER DR, MURRIETA, CA 92562-5965
(760) 731-3334
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0092911
—
CA
Enumeration date
04/10/2006
Last updated
08/04/2008
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