Active NPI
Oncotech Inc
- Clinical Medical Laboratory
- Tustin, CA
National Provider Identifier
1750494209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- 4785-STATE LICENSE
- Legal business name
- ONCOTECH INC
- Doing business as
- Exiqon Diagnostics
- Practice address
- 15501 Red Hill Avenue
Tustin, CA 92780 - Phone
- (714) 566-0420
- Fax
- (714) 566-0471
- NPI assigned
- Aug 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Mark Willig
- Title
- Chief Commercial Officer
- Phone
- (714) 566-0470
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | CLF 4785 | CA | |
| Clinical Medical Laboratory | 291U00000X | 4785-STATE LICENSE | CA | Primary |
Addresses
Primary practice location
15501 Red Hill Avenue
Tustin, CA 92780
Mailing address
15501 Red Hill Avenue
Tustin, CA 92780
Phone (714) 566-0420
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01464390 | Medicaid | PA | |
| 030483200 | Medicaid | FL | |
| 160820 | Medicaid | AZ | |
| 100384230A | Medicaid | IN | |
| LAB09008F | Medicaid | CA | |
| 0805289 | Medicaid | MD | |
| 100245170A | Medicaid | KS | |
| L00034 | Medicaid | SC | |
| 7001073 | Medicaid | NC | |
| 125472709 | Medicaid | AK | |
| 98002652 | Medicaid | CO | |
| 37903010 | Medicaid | KY | |
| X059008 | Medicaid | CA | |
| 4490705 | Medicaid | TN | |
| 6228003 | Medicaid | NJ | |
| 00768644A | Medicaid | GA | |
| 7060627 | Medicaid | WA | |
| 707653606 | Medicaid | MO |
Other names 1
- Exiqon Diagnostics
National Provider Directory
National Provider DirectoryLocations
15501 Red Hill Ave
Tustin, CA 92780
Phone (714) 566-0420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1265587200000",
"number": "1750494209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15501 RED HILL AVENUE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "92780",
"telephone_number": "714-566-0420",
"fax_number": "714-566-0471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15501 RED HILL AVENUE",
"city": "TUSTIN",
"state": "CA",
"postal_code": "92780",
"telephone_number": "714-566-0420",
"fax_number": "714-566-0471"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ONCOTECH INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-17",
"last_updated": "2010-02-08",
"status": "A",
"authorized_official_last_name": "WILLIG",
"authorized_official_first_name": "MARK",
"authorized_official_title_or_position": "CHIEF COMMERCIAL OFFICER",
"authorized_official_telephone_number": "714-566-0470",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "CA",
"license": "CLF 4785",
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "CA",
"license": "4785-STATE LICENSE",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01464390",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "030483200",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "160820",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100384230A",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LAB09008F",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0805289",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100245170A",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "L00034",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7001073",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "125472709",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "98002652",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "37903010",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "X059008",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4490705",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6228003",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00768644A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7060627",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "707653606",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Exiqon Diagnostics",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tustin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.