Provider Demographics
NPI:1245637313
Name:FORTRESS DIAGNOSTICS TESTING INC
Entity type:Organization
Organization Name:FORTRESS DIAGNOSTICS TESTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:KUMAR BEZWA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-946-4566
Mailing Address - Street 1:1801 EXCISE AVENUE
Mailing Address - Street 2:108
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8555
Mailing Address - Country:US
Mailing Address - Phone:909-285-2278
Mailing Address - Fax:909-296-7978
Practice Address - Street 1:1801 EXCISE AVENUE
Practice Address - Street 2:108
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8555
Practice Address - Country:US
Practice Address - Phone:909-285-2278
Practice Address - Fax:909-296-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL00086632291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory