Healthcare Provider Details

I. General information

NPI: 1730426453
Provider Name (Legal Business Name): TOXICOLOGY MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 COUNTRY CLUB DR # B126
SIMI VALLEY CA
93065-0637
US

IV. Provider business mailing address

543 COUNTRY CLUB DR # B126
SIMI VALLEY CA
93065-0637
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-1648
  • Fax: 805-823-6519
Mailing address:
  • Phone: 805-416-1648
  • Fax: 805-823-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CORT COLBERT
Title or Position: BDM
Credential:
Phone: 805-522-9274