1598164998 NPI number — CENTURION TOXICOLOGY SERVICES,LLC

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 1598164998 NPI number — CENTURION TOXICOLOGY SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTURION TOXICOLOGY SERVICES,LLC
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:
1598164998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 S OLD SPRINGS RD
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92808-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-464-1440
Provider Business Mailing Address Fax Number:
714-464-1466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 S OLD SPRINGS RD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92808-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-464-1440
Provider Business Practice Location Address Fax Number:
714-464-1466
Provider Enumeration Date:
08/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GAETA
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
714-464-1440

Provider Taxonomy Codes

  • 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)





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