Provider Demographics
NPI:1144357948
Name:SAN DIEGO COUNTY PUBLIC HEALTH LABORATORY
Entity type:Organization
Organization Name:SAN DIEGO COUNTY PUBLIC HEALTH LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCVAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-692-8500
Mailing Address - Street 1:3851 ROSECRANS ST
Mailing Address - Street 2:MS P572
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8500
Mailing Address - Fax:619-692-8558
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:SUITE 716
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8500
Practice Address - Fax:619-692-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0060808291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB60608FMedicaid