Provider Demographics
NPI:1598164998
Name:CENTURION TOXICOLOGY SERVICES,LLC
Entity Type:Organization
Organization Name:CENTURION TOXICOLOGY SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-464-1440
Mailing Address - Street 1:160 S OLD SPRINGS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1260
Mailing Address - Country:US
Mailing Address - Phone:714-464-1440
Mailing Address - Fax:714-464-1466
Practice Address - Street 1:160 S OLD SPRINGS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1260
Practice Address - Country:US
Practice Address - Phone:714-464-1440
Practice Address - Fax:714-464-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory