1891792875 NPI number — REDWOOD TOXICOLOGY LABORATORY, INC.

Table of content: (NPI 1891792875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891792875 NPI number — REDWOOD TOXICOLOGY LABORATORY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDWOOD TOXICOLOGY LABORATORY, 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:
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:
1891792875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3650 WESTWIND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95403-1066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-255-2159
Provider Business Mailing Address Fax Number:
707-569-1442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 WESTWIND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95403-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-255-2159
Provider Business Practice Location Address Fax Number:
707-569-1442
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
800-255-2159

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 3738 , 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: 1149781 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAB07588F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37000692 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0563635 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410780000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98003262 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4490625 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806553300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: LB588CA , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690000004 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200305900A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 429190500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 769630 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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