Organization
INTERNIST LABORATORY
Active
Parent organization
INTERNIST LABORATORY - CANOGA
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERNIST LABORATORY - CANOGA
Authorized official
DAVID MORGAN II (CEO)
(562) 906-5227
Entity
Organization
Contact information
Practice address
21018 OSBORNE ST, SUITE 3, CANOGA PARK, CA 91304-1757
(562) 906-5227
Mailing address
10200 PIONEER BLVD, SUITE 500, SANTA FE SPRINGS, CA 90670-6000
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF4149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0696979
CLIA
CA
Enumeration date
06/25/2015
Last updated
01/19/2016
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