=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740519446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESEARCHDX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2009
-----------------------------------------------------
Last Update Date | 04/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 MASON SUITE 100
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-812-6902
-----------------------------------------------------
Fax | 949-297-3983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 MASON SUITE 100
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-812-6902
-----------------------------------------------------
Fax | 949-297-3983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LABORATORY DIRECTOR
-----------------------------------------------------
Name | DR. PHILIP D COTTER
-----------------------------------------------------
Credential | PHD, FACMG
-----------------------------------------------------
Telephone | 510-332-0477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | CLF339055
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------