| Certificate | Number | ||
05D0550276 |
|||
22584-04 |
|||
HEW CLIA Exempt Number |
04-1184 |
||
Medicare Number |
X059311 |
||
Medi-Cal Number |
LAB50276F |
||
| National Provider | (NPI) 1013900778 | ||
CLF3096 |
|||
800010357 |
|||
788 |
|||
805098B6 |
|||
| State of Pennsylvania | 029006 | ||
| State of Rhode Island | LCO00386 |