Organization
REYMUNDO NOUR
Active
Other names
MEDICAL LAB CO.
Organization subpart
No
Provider details
NPI number
Authorized official
REYMUNDO NOUR (MANAGER)
(760) 600-5825
Entity
Organization
Contact information
Practice address
81626 US HIGHWAY 111, INDIO, CA 92201-5413
(760) 600-5825
Mailing address
81626 US HIGHWAY 111, INDIO, CA 92201-5413
(760) 600-5825
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
CLR00343403
CA
291U00000X
Clinical Medical Laboratory
—
—
363L00000X
Nurse Practitioner
CLR00343403
CA
Other
Enumeration date
01/29/2013
Last updated
06/19/2014
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