Immunetech, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF 11721 Issued in CA

Legal business name

IMMUNETECH, INC

Practice address

3856 Bay Center PL
Hayward, CA 94545-3619

Phone

(650) 312-1066

Fax

(888) 275-3505

NPI assigned

Oct 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Elkins

Title

Chief Executive Officer

Phone

(415) 717-8064

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1003366964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3856 BAY CENTER PL",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945453619",
            "telephone_number": "650-312-1066",
            "fax_number": "888-275-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3856 BAY CENTER PL",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945453619",
            "telephone_number": "650-312-1066",
            "fax_number": "888-275-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMUNETECH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-04",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "ELKINS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "415-717-8064"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF 11721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI",
            "identifier": "1952601593",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adekunle Ige, ASW
• Trixia-Marie Carbonell Iglesias, RN
• Iheart Imaging
• Anastacia Iliili
• Ina Imasa
• Vannesa Imperial
• Suzan Chen Inadomi, O.D.
• Independent Quality Care
• Aaliyah Infante
• Dionisia Maria Inocencio

• Clinical Medical Laboratory in Hayward, CA
• Providers in Hayward, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.