Organization
CRESTVIEW CLINICAL LABORATORY
Active
Organization
CRESTVIEW CLINICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROY BERGLUND M.D. (MEDICAL DIRECTOR)
(559) 781-6975
Entity
Organization
Contact information
Practice address
460 W PUTNAM AVE, PORTERVILLE, CA 93257-3321
(559) 781-6975
(559) 783-2084
Mailing address
460 W PUTNAM AVE, PORTERVILLE, CA 93257-3321
(559) 781-6975
(559) 783-2084
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D0930808
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAB30808F
—
CA
Enumeration date
07/11/2006
Last updated
10/17/2008
Update your record
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