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General NPI Number Information
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NPI Number | 1215377882
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Entity Type | Organization
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Legal Business Name | SUPERIOR TOXICOLOGY MANAGEMENT ,LLC
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 22471 IVY RDG
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City | MISSION VIEJO
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State | CA
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Zip | 92692-4549
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Country | US
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Telephone | 949-654-9004
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Fax | 949-654-9005
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Provider Business Mailing Address
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Address Line | PO BOX 50340
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City | IRVINE
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State | CA
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Zip | 92619-0340
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Country | US
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Telephone | 949-456-9004
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Fax | 949-645-9005
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Authorized Official
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Title or Position | MANAGR
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Name | MR. MIKE M. RAKAB
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Credential |
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Telephone | 949-645-9004
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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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