Provider Demographics
NPI:1326658097
Name:RDR HOLDINGS LLC
Entity Type:Organization
Organization Name:RDR HOLDINGS LLC
Other - Org Name:BALBOA DX LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAINONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-230-9080
Mailing Address - Street 1:26359 JEFFERSON AVE STE G
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6975
Mailing Address - Country:US
Mailing Address - Phone:760-230-9080
Mailing Address - Fax:
Practice Address - Street 1:26359 JEFFERSON AVE STE G
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6975
Practice Address - Country:US
Practice Address - Phone:760-230-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory