Provider Demographics
NPI:1215377882
Name:SUPERIOR TOXICOLOGY MANAGEMENT ,LLC
Entity Type:Organization
Organization Name:SUPERIOR TOXICOLOGY MANAGEMENT ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAKAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-645-9004
Mailing Address - Street 1:PO BOX 50340
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0340
Mailing Address - Country:US
Mailing Address - Phone:949-456-9004
Mailing Address - Fax:949-645-9005
Practice Address - Street 1:22471 IVY RDG
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-4549
Practice Address - Country:US
Practice Address - Phone:949-654-9004
Practice Address - Fax:949-654-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory