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General NPI Number Information
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NPI Number | 1528162104
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Entity Type | Organization
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Legal Business Name | AERON BIOTECHNOLOGY INC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1933 DAVIS STREET SUITE 310
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City | SAN LEANDRO
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State | CA
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Zip | 94577
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Country | US
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Telephone | 510-729-0375
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Fax | 510-729-0383
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Provider Business Mailing Address
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Address Line | 1933 DAVIS STREET SUITE 310
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City | SAN LEANDRO
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State | CA
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Zip | 94577
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Country | US
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Telephone | 510-729-0375
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Fax | 510-729-0383
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Authorized Official
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Title or Position | VICE PRESIDENT MEDICAL DIRECTOR
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Name | CHARLES M DOLLBAUM
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Credential | MD PHD
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Telephone | 510-729-0375
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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 | PFI7360805171AZ
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800001949
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLIA05D0600602
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License Number State | CA
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