Provider Demographics
NPI:1548595747
Name:STANFORD BLOOD CENTER, LLC
Entity Type:Organization
Organization Name:STANFORD BLOOD CENTER, LLC
Other - Org Name:HISTOCOMPATIBILITY, IMMUNOGENETICS AND DISEASE PROFILING LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HARPRIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-723-7994
Mailing Address - Street 1:3373 HILLVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1204
Mailing Address - Country:US
Mailing Address - Phone:650-723-5548
Mailing Address - Fax:650-723-6350
Practice Address - Street 1:3373 HILLVIEW AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-723-5548
Practice Address - Fax:650-723-6350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANFORD HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-06
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF2822291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF00002822OtherCLINICAL LABORATORY LICENSE
AL066CA082OtherTHE AMERICAN SOCIETY FOR HISTOCOMPATIBILITY & IMMUNOGENETICS
05D0718472OtherCLIA CERTIFICATE