1487876116 NPI number — ALAMEDA COUNTY PUBLIC HEALTH LABORATORY

Table of content: (NPI 1487876116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487876116 NPI number — ALAMEDA COUNTY PUBLIC HEALTH LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAMEDA COUNTY PUBLIC HEALTH LABORATORY
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:
1487876116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 PERALTA OAKS CT
Provider Second Line Business Mailing Address:
ROOM 206
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94605-5319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-382-4300
Provider Business Mailing Address Fax Number:
510-382-4333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 PERALTA OAKS CT
Provider Second Line Business Practice Location Address:
ROOM 206
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94605-5319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-382-4300
Provider Business Practice Location Address Fax Number:
510-382-4333
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANDORI
Authorized Official First Name:
MARK
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
DIRECTOR, LABORATORY SERVICES
Authorized Official Telephone Number:
510-382-4300

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  05D0601931 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , 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: 05D2090025 . This is a "CLIA ID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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