Provider Demographics
NPI:1568817617
Name:FORENSIC BLOOD SERVICES
Entity Type:Organization
Organization Name:FORENSIC BLOOD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MENJIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:707-540-1225
Mailing Address - Street 1:5750 IAN CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-2254
Mailing Address - Country:US
Mailing Address - Phone:707-540-1225
Mailing Address - Fax:916-723-5856
Practice Address - Street 1:5750 IAN CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95842-2254
Practice Address - Country:US
Practice Address - Phone:707-540-1225
Practice Address - Fax:916-723-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPA3892253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care