Basic Information
| Provider Information | |||||||||
| NPI: | 1912383183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PMDCA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3440 N 16TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816261212 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23297 S POINTE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494879500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2015 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7816261212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.