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General NPI Number Information
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NPI Number | 1750494209
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Entity Type | Organization
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Legal Business Name | ONCOTECH INC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 15501 RED HILL AVENUE
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-566-0420
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Fax | 714-566-0471
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Provider Business Mailing Address
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Address Line | 15501 RED HILL AVENUE
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-566-0420
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Fax | 714-566-0471
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Authorized Official
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Title or Position | CHIEF COMMERCIAL OFFICER
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Name | MR. MARK WILLIG
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Credential |
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Telephone | 714-566-0470
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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 | CLF 4785
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License Number State | CA
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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 | 4785-STATE LICENSE
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License Number State | CA
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