1750494209 NPI number — ONCOTECH INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750494209 NPI number — ONCOTECH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONCOTECH INC
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:
EXIQON DIAGNOSTICS
Provider Other Organization Name Type Code:
3
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:
1750494209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15501 RED HILL AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-566-0420
Provider Business Mailing Address Fax Number:
714-566-0471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15501 RED HILL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-566-0420
Provider Business Practice Location Address Fax Number:
714-566-0471
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIG
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMMERCIAL OFFICER
Authorized Official Telephone Number:
714-566-0470

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 4785 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 4785-STATE LICENSE , 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: 01464390 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030483200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160820 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100384230A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAB09008F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0805289 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100245170A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: L00034 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7001073 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125472709 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98002652 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37903010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: X059008 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4490705 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6228003 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00768644A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7060627 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 707653606 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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