Provider Demographics
NPI:1164759650
Name:ALLIANCE TOXICOLOGY LLC
Entity Type:Organization
Organization Name:ALLIANCE TOXICOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-496-6164
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:PMB 190
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-5000
Mailing Address - Country:US
Mailing Address - Phone:714-496-6164
Mailing Address - Fax:
Practice Address - Street 1:540 N GOLDEN CIRCLE DR
Practice Address - Street 2:SUITE #215
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3914
Practice Address - Country:US
Practice Address - Phone:714-496-6164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory