Provider Demographics
NPI:1013801653
Name:IRVINE DIAGNOSTIC LABORATORY
Entity type:Organization
Organization Name:IRVINE DIAGNOSTIC LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLAMAGGIORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-254-6490
Mailing Address - Street 1:15520 ROCKFIELD BLVD STE H1
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2764
Mailing Address - Country:US
Mailing Address - Phone:949-254-6490
Mailing Address - Fax:
Practice Address - Street 1:15520 ROCKFIELD BLVD STE H1
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2764
Practice Address - Country:US
Practice Address - Phone:949-254-6490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EQUAL DIAGNOSTIC SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2295363OtherCLIA NUMBER