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General NPI Number Information
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NPI Number | 1164759650
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Entity Type | Organization
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Legal Business Name | ALLIANCE TOXICOLOGY LLC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 540 N GOLDEN CIRCLE DR SUITE #215
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City | SANTA ANA
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State | CA
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Zip | 92705-3914
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Country | US
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Telephone | 714-496-6164
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5000 PMB 190
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067-5000
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Country | US
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Telephone | 714-496-6164
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KIM ANGELES HANSEN
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Credential |
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Telephone | 714-496-6164
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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 |
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License Number State |
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