Provider Demographics
NPI:1194493007
Name:AFMC DIAMOND LAB
Entity type:Organization
Organization Name:AFMC DIAMOND LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-777-8888
Mailing Address - Street 1:1370 VALLEY VISTA DR STE 135
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3950
Mailing Address - Country:US
Mailing Address - Phone:909-777-8888
Mailing Address - Fax:909-551-0200
Practice Address - Street 1:1370 VALLEY VISTA DR STE 135
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3950
Practice Address - Country:US
Practice Address - Phone:909-777-8888
Practice Address - Fax:909-551-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty