Magnolia Diagnostic Center,inc
Clinical Medical Laboratory in Clovis, NM. Organization (NPI-2).
NPI number1710057740
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1710057740
- Entity type
- Organization (NPI-2)
- Legal business name
- Magnolia Diagnostic Center,inc
- Organization subpart
- No
- Enumeration date
- Nov 8, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 291U00000X | Clinical Medical Laboratory | 32D1060534 | NM | Yes |
Practice location
2100 N Dr Martin Luther King Jr BlvdClovis, NM 88101-9412
Phone 509-389-9765 · Fax 505-213-0132
Mailing address
2100 N Dr Martin Luther King Jr BlvdClovis, NM 88101-9412
Phone 509-389-9765 · Fax 505-213-0132
Authorized official
Ramon Gutierrez
President
5093899765
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