Organization
GULFPORT TESTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST R RANDALL (CEO)
(818) 235-9054
Entity
Organization
Contact information
Practice address
9245 RESEDA BLVD, STE 744, NORTHRIDGE, CA 91324-3137
(818) 235-9054
Mailing address
9245 RESEDA BLVD, STE 744, NORTHRIDGE, CA 91324-3137
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D1104392
CA
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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