Provider Demographics
NPI:1891792875
Name:REDWOOD TOXICOLOGY LABORATORY, INC.
Entity Type:Organization
Organization Name:REDWOOD TOXICOLOGY LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-255-2159
Mailing Address - Street 1:3650 WESTWIND BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1066
Mailing Address - Country:US
Mailing Address - Phone:800-255-2159
Mailing Address - Fax:707-569-1442
Practice Address - Street 1:3650 WESTWIND BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1066
Practice Address - Country:US
Practice Address - Phone:800-255-2159
Practice Address - Fax:707-569-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 3738291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1149781Medicaid
CALAB07588FMedicaid
KY37000692Medicaid
IA0563635Medicaid
ME410780000Medicaid
CO98003262Medicaid
MI4490625Medicaid
ID806553300Medicaid
AKLB588CAMedicaid
AL690000004Medicaid
IN200305900AMedicaid
MD429190500Medicaid
AZ769630Medicaid