Provider Demographics
NPI:1487876116
Name:ALAMEDA COUNTY PUBLIC HEALTH LABORATORY
Entity type:Organization
Organization Name:ALAMEDA COUNTY PUBLIC HEALTH LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, LABORATORY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PANDORI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-382-4300
Mailing Address - Street 1:2901 PERALTA OAKS CT
Mailing Address - Street 2:ROOM 206
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5319
Mailing Address - Country:US
Mailing Address - Phone:510-382-4300
Mailing Address - Fax:510-382-4333
Practice Address - Street 1:2901 PERALTA OAKS CT
Practice Address - Street 2:ROOM 206
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5319
Practice Address - Country:US
Practice Address - Phone:510-382-4300
Practice Address - Fax:510-382-4333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ALAMEDA DEPT. OF PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0601931291U00000X
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2090025OtherCLIA ID NUMBER
CA05D2090025OtherCLIA ID NUMBER
CAZZZ58535ZMedicare ID - Type Unspecified