Organization
COMMUNITY HEALTH CLINICAL LABORATORY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRE FEOKTISTOV (PRESIDENT)
(805) 338-0460
Entity
Organization
Contact information
Practice address
150 TEJAS PLACE, BLDG. B SUITE A, NIPOMO, CA 93444
(805) 338-0460
Mailing address
150 TEJAS PLACE, BLDG. B SUITE A, NIPOMO, CA 93444
(805) 338-0460
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
03/18/2020
Last updated
03/19/2020
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