Organization
CANDU LAB SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD KENT STIVERSON (CEO/PRESIDENT)
(719) 289-2351
Entity
Organization
Contact information
Practice address
400 S UNION AVE, SUITE B, PUEBLO, CO 81003-3431
(719) 289-2351
Mailing address
15904 STRATHERN ST, SUITE 19, VAN NUYS, CA 91406-1314
(719) 289-2351
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
DR-23150
CO
Other
Enumeration date
02/25/2008
Last updated
12/18/2008
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