Organization
WESTERN CLINICAL LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM J KEENAN MD (LABORATORY DIRECTOR)
(916) 783-5201
Entity
Organization
Contact information
Practice address
408 SUNRISE AVE, SUITE 1, ROSEVILLE, CA 95661
(916) 783-5201
(916) 783-5286
Mailing address
408 SUNRISE AVE, SUITE 1, ROSEVILLE, CA 95661
(916) 783-5201
(916) 783-5286
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 1739
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ36227Z
OLD PROVIDER NUMBER
CA
Enumeration date
07/02/2008
Last updated
07/03/2008
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