MITOMED DIAGNOSTICS LABORATORY (NPI# 1356595011) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356595011 |
| Entity Type | Organization |
| Organization Name | MITOMED DIAGNOSTICS LABORATORY |
| Practice Address |
2501 Hewitt Hl University of California Irvine Irvine CA 92697-0001 |
| Practice Telephone | 9498241886 |
| Practice Fax Number | 9498246388 |
| Mailing Telephone | 9498241886 |
| Mailing Fax Number | 9498246388 |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2008-11-07 |
| Authorized Official Name | PROF. DOUGLAS C. WALLACE (LABORATORY DIRECTOR) |
| Authorized Official Telephone | 9498243490 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | 05D1034314 | CA | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CLIA | 05D1034314 | 01 |
| Street Address |
2501 HEWITT HL UNIVERSITY OF CALIFORNIA IRVINE |
| City | IRVINE |
| State | CA |
| Zip Code | 92697-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174001507 | Melanie Bernus Tallakson | Nurse Practitioner | 1100 Gottschalk Medical Plaza, Irvine, CA 92697 | 2018-07-28 |
| 1134514888 | Jessica Shiu | Dermatology | 118 Medical Surge 1, Irvine, CA 92697 | 2015-03-31 |
| 1649513508 | Melissa Shive | Dermatology | Uci Dermatology 1 Medical Plaza Drive, Irvine, CA 92697 | 2013-03-29 |
| 1760740526 | Adam Mason | Anesthesiology | 101 The City Dr. S., Uci Department of Anesthesiology, Anaheim, CA 92697 | 2012-04-30 |
| 1295966489 | Thu Michelle Tran | Nurse Practitioner | C240 Medical Science I, Uci Infusion Center, Irvine, CA 92697 | 2009-08-05 |
| 1760667554 | Catherine Marie Mcadams-ortiz | Nurse Practitioner | 1100 Gottschalk Medical Plaza Drive, University of California, Irvine, Irvine, CA 92697 | 2007-12-31 |
| 1386767630 | Gary W Cole | Dermatology | Dept. of Dermatology, Univ. of Calif., Irvine, Medical Sciences 1, Rm C340, Irvine, CA 92697 | 2007-04-09 |
| 1982729786 | Helen C. Tseng | Ophthalmology | 118 Med Surge 1 Attn Karen Tighe, Uc Irvine, Dept of Ophthalmology, Irvine, CA 92697 | 2007-03-20 |
| 1710065453 | Ronald Kurtz | Ophthalmology | 118 Med Surge 1, University of California, Irvine, Irvine, CA 92697 | 2006-11-01 |
| 1871509026 | Vivien Chan | Psychiatry & Neurology | 501 Student Health, Irvine, CA 92697 | 2006-07-31 |
| Find all providers in zip 92697 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1346713989 | Genomic Testing Cooperative Lca | Clinical Medical Laboratory | 175 Technology Dr Ste 100, Irvine, CA 92618-2473 | 2019-01-07 |
| 1134697196 | Sbh Labs | Clinical Medical Laboratory | 17952 Sky Park Cir Ste J, Irvine, CA 92614-4417 | 2018-11-08 |
| 1174000830 | Sunshine Behavioral Health Partners LLC | Clinical Medical Laboratory | 17975 Sky Park Cir Ste B, Irvine, CA 92614-6330 | 2018-07-25 |
| 1194201558 | Cleanquest LLC | Clinical Medical Laboratory | 17952 Sky Park Cir Ste K, Irvine, CA 92614-4416 | 2018-07-18 |
| 1356844260 | Vision Clinical Laboratory | Clinical Medical Laboratory | 18011 Sky Park Cir Ste N, Irvine, CA 92614-6517 | 2018-03-16 |
| 1861994600 | Healthquest Esoterics Inc | Clinical Medical Laboratory | 6 Bendix, Irvine, CA 92618-2006 | 2018-03-07 |
| 1316311863 | Genetic Testing Laboratory | Clinical Medical Laboratory | 18 Technology Dr Ste 107, Irvine, CA 92618-2309 | 2015-11-20 |
| Find all providers in IRVINE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.