Organization
SAN DIEGO STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BURNS (ASSOCIATE VICE PRESIDENT)
(619) 594-6018
Entity
Organization
Contact information
Practice address
5500 CAMPANILE DR, SAN DIEGO, CA 92182-4701
(619) 594-4325
(619) 594-4260
Mailing address
5500 CAMPANILE DR, SAN DIEGO, CA 92182-4701
(619) 594-4325
(619) 594-4260
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF1921
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAB60831F
—
CA
Enumeration date
08/30/2006
Last updated
08/22/2020
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