Provider Demographics
NPI:1598568685
Name:IMPERIAL CLINICAL & PATHOLOGY LAB LLC
Entity type:Organization
Organization Name:IMPERIAL CLINICAL & PATHOLOGY LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-604-4233
Mailing Address - Street 1:778 AGUA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4302
Mailing Address - Country:US
Mailing Address - Phone:760-604-4233
Mailing Address - Fax:619-934-4948
Practice Address - Street 1:2026 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1607
Practice Address - Country:US
Practice Address - Phone:760-592-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory