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General NPI Number Information
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NPI Number | 1851636450
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Entity Type | Organization
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Legal Business Name | PACIFIC TOXICOLOGY MANAGEMENT, INC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 980 ENCHANTED WAY STE 211
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City | SIMI VALLEY
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State | CA
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Zip | 93065-0914
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Country | US
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Telephone | 805-522-9274
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 MADERA RD # N182
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City | SIMI VALLEY
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State | CA
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Zip | 93065-3077
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BDM
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Name | CORT COLBERT
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Credential |
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Telephone | 805-522-9274
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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 |
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License Number State |
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