Provider Demographics
NPI:1568133411
Name:PRG TECHNOLOGIES, INC
Entity Type:Organization
Organization Name:PRG TECHNOLOGIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASEER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CLS
Authorized Official - Phone:714-493-1224
Mailing Address - Street 1:1020 S ANAHEIM BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5808
Mailing Address - Country:US
Mailing Address - Phone:714-215-4354
Mailing Address - Fax:714-215-4324
Practice Address - Street 1:1020 S ANAHEIM BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5808
Practice Address - Country:US
Practice Address - Phone:714-215-4354
Practice Address - Fax:714-215-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDF-90001611OtherSTATE OF CALIFORNIA LABORATORY LICENSE
CA05D2193318OtherCLIA CERTIFICATE