Provider Demographics
NPI:1215166939
Name:SOUTH COAST CLINICAL LABORATORIES
Entity type:Organization
Organization Name:SOUTH COAST CLINICAL LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-387-8700
Mailing Address - Street 1:5 MIDNIGHT LN
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-5905
Mailing Address - Country:US
Mailing Address - Phone:310-387-8700
Mailing Address - Fax:
Practice Address - Street 1:15326 CORNET ST
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-5532
Practice Address - Country:US
Practice Address - Phone:310-387-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 10499291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory