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General NPI Number Information
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NPI Number | 1508157520
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Entity Type | Organization
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Legal Business Name | BLOOD BANK OF SAN BERNARDINO AND RIVERSIDE COUNTIES
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 384 W ORANGE SHOW RD
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2028
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Country | US
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Telephone | 909-885-6503
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Fax | 909-381-2036
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Provider Business Mailing Address
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Address Line | PO BOX 5729
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City | SAN BERNARDINO
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State | CA
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Zip | 92412-5729
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Country | US
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Telephone | 909-885-6503
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Fax | 909-381-2036
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Authorized Official
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Title or Position | PRESIDENT/CEO/MEDICAL DIRECTOR
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Name | DR. FREDERICK B AXELROD
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Credential | M.D. , MBA
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Telephone | 909-885-6503
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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 | CLF3556
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 331L00000X
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Taxonomy Name | Blood Bank
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License Number | 9021
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License Number State | CA
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