Fortress Diagnostics Testing Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

BL00086632 Issued in CA

Legal business name

FORTRESS DIAGNOSTICS TESTING INC

Practice address

1801 Excise Avenue
108
Ontario, CA 91761-8555

Phone

(909) 285-2278

Fax

(909) 296-7978

NPI assigned

Dec 4, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Sudhir Kumar Bezwa Reddy, M.D.

Title

President

Phone

(909) 946-4566

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1417651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1245637313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 EXCISE AVENUE",
            "address_2": "108",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618555",
            "telephone_number": "909-285-2278",
            "fax_number": "909-296-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 EXCISE AVENUE",
            "address_2": "108",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618555",
            "telephone_number": "909-285-2278",
            "fax_number": "909-296-7978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTRESS DIAGNOSTICS TESTING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-04",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "SUDHIR",
        "authorized_official_middle_name": "KUMAR BEZWA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-946-4566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "BL00086632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christall Ford
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• De'Lana La'Shawn Fowler, L.V.N.

• Clinical Medical Laboratory in Ontario, CA
• Providers in Ontario, 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 Dec 4, 2014; 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.