Organization
SAN MARCOS MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AZER REZK (ADMINISTRATER)
(909) 376-7715
Entity
Organization
Contact information
Practice address
1574 W BASE LINE ST STE 107, SAN BERNARDINO, CA 92411-1736
(909) 386-1880
(909) 386-1882
Mailing address
1574 W BASE LINE ST STE 107, SAN BERNARDINO, CA 92411-1736
(909) 386-1880
(909) 386-1882
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
LAB 69268F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAB69268F
—
CA
Enumeration date
01/29/2007
Last updated
08/22/2020
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