Provider Demographics
NPI:1598138562
Name:EQUALTOX, LLC
Entity Type:Organization
Organization Name:EQUALTOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRANFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-760-4804
Mailing Address - Street 1:550 N GOLDEN CIRCLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3978
Mailing Address - Country:US
Mailing Address - Phone:714-760-4804
Mailing Address - Fax:714-852-3643
Practice Address - Street 1:550 N GOLDEN CIRCLE DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3978
Practice Address - Country:US
Practice Address - Phone:714-760-4804
Practice Address - Fax:714-852-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLP00305415291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory