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General NPI Number Information
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NPI Number | 1053395996
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Entity Type | Organization
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Legal Business Name | BERKELEY HEARTLAB INC
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 960 ATLANTIC AVE SUITE 100
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City | ALAMEDA
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State | CA
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Zip | 94501-1066
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Country | US
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Telephone | 510-747-1740
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Fax | 510-747-1924
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Provider Business Mailing Address
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Address Line | 468 LITTLEFIELD AVENUE
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-6105
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Country | US
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Telephone | 650-967-4500
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Fax | 650-697-8724
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | JONATHAN WOLIN
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Credential |
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Telephone | 650-651-3109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 023440
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License Number State | CA
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