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General NPI Number Information
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NPI Number | 1093953523
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Entity Type | Organization
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Legal Business Name | SUTTER HEALTH SHARED LABORATORY
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 2950 COLLIER CANYON RD
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City | LIVERMORE
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State | CA
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Zip | 94551-9224
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Country | US
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Telephone | 925-371-3800
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Fax | 925-371-3810
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Provider Business Mailing Address
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Address Line | 2950 COLLIER CANYON RD
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City | LIVERMORE
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State | CA
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Zip | 94551-9224
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Country | US
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Telephone | 925-371-3800
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Fax | 925-371-3810
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | RONALD D WORKMAN
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Credential | M.D.
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Telephone | 916-286-6731
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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 | CLF265
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License Number State | CA
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