Provider Demographics
NPI:1083928576
Name:ASPEN TOXICOLOGY, LLC
Entity Type:Organization
Organization Name:ASPEN TOXICOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-608-1724
Mailing Address - Street 1:1524 BROOKHOLLOW DRIVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:949-608-1724
Mailing Address - Fax:949-743-5862
Practice Address - Street 1:1524 BROOKHOLLOW DR
Practice Address - Street 2:SUITE 7
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5426
Practice Address - Country:US
Practice Address - Phone:949-608-1724
Practice Address - Fax:949-743-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies