Organization
SPECTRUM MOLECULAR DIAGNOSTICS LABORATORY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICK FERGUSON (PRESIDENT / CEO)
(714) 928-3162
Entity
Organization
Contact information
Practice address
30151 AVENIDA DE LAS BANDERA STE B, RANCHO SANTA MARGARITA, CA 92688-2170
(949) 264-6102
Mailing address
30151 AVENIDA DE LAS BANDERA, RANCHO SANTA MARGARITA, CA 92688-2170
(949) 264-6102
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2232585
CLIA
CA
Enumeration date
08/16/2021
Last updated
08/15/2023
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