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General NPI Number Information
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NPI Number | 1598138562
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Entity Type | Organization
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Legal Business Name | EQUALTOX, LLC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 550 N GOLDEN CIRCLE DR STE B
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City | SANTA ANA
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State | CA
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Zip | 92705-3978
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Country | US
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Telephone | 714-760-4804
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Fax | 714-852-3643
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Provider Business Mailing Address
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Address Line | 550 N GOLDEN CIRCLE DR STE B
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City | SANTA ANA
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State | CA
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Zip | 92705-3978
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Country | US
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Telephone | 714-760-4804
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Fax | 714-852-3643
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CRANFORD L SCOTT
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Credential | MD
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Telephone | 714-760-4804
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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 | CLP00305415
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License Number State | CA
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