Provider Demographics
NPI:1679682322
Name:REDWOOD DIAGNOSTICS ASSOCIATES
Entity Type:Organization
Organization Name:REDWOOD DIAGNOSTICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VOGELSANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:707-826-1342
Mailing Address - Street 1:3798 JANES RD STE 12
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4745
Mailing Address - Country:US
Mailing Address - Phone:707-826-1342
Mailing Address - Fax:
Practice Address - Street 1:3798 JANES RD STE 12
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4745
Practice Address - Country:US
Practice Address - Phone:707-826-1342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 10079291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB77806FMedicaid
CAZZZ29929ZMedicare PIN