1326448069 NPI number — GLOBAL DISCOVERY BIOSCIENCES CORPORATION

Table of content: (NPI 1326448069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326448069 NPI number — GLOBAL DISCOVERY BIOSCIENCES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOBAL DISCOVERY BIOSCIENCES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326448069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13885 ALTON PKWY STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-208-6140
Provider Business Mailing Address Fax Number:
888-424-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13885 ALTON PKWY STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-208-6140
Provider Business Practice Location Address Fax Number:
888-424-7505
Provider Enumeration Date:
08/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
949-547-3140

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 00340854 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CLF 00340854 . This is a "CALIFORNIA DOH LFS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D2020794 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 106501600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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