Healthcare Provider Details

I. General information

NPI: 1205040300
Provider Name (Legal Business Name): BLOOD BANK OF SAN BERNARDINO & RIVERSIDE COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 WEST ORANGE SHOW ROAD
SAN BERNARDINO CA
92412-5729
US

IV. Provider business mailing address

384 WEST ORANGE SHOW ROAD
SAN BERNARDINO CA
92412-5729
US

V. Phone/Fax

Practice location:
  • Phone: 909-885-6503
  • Fax: 909-381-2036
Mailing address:
  • Phone: 909-885-6503
  • Fax: 909-381-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. FREDERICK B AXELROD
Title or Position: PRESIDENT CEO
Credential:
Phone: 909-885-6503