1124050380 NPI number — ADJ CORPORATION

Table of content: (NPI 1124050380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124050380 NPI number — ADJ CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADJ 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:
6
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:
1124050380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90670-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-906-5227
Provider Business Mailing Address Fax Number:
562-906-6450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10200 PIONEER BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
SANTA FE SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90670-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-906-5227
Provider Business Practice Location Address Fax Number:
562-906-6450
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ENDOSO
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-906-5227

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 10371 , 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: LAB76459F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CLF 10371 . This is a "CLINICAL LABORATORY LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0866459 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com