Provider Demographics
NPI:1689930687
Name:QUANTUM TOXICOLOGY
Entity Type:Organization
Organization Name:QUANTUM TOXICOLOGY
Other - Org Name:QUANTUM TOXICOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER (SOLE PROPRIETOR)
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:CARDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-613-1396
Mailing Address - Street 1:1211 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651
Mailing Address - Country:US
Mailing Address - Phone:949-715-3411
Mailing Address - Fax:949-715-1161
Practice Address - Street 1:1211 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-715-3411
Practice Address - Fax:949-715-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherINFO