Provider Demographics
NPI:1124050380
Name:ADJ CORPORATION
Entity type:Organization
Organization Name:ADJ CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-906-5227
Mailing Address - Street 1:PO BOX 2339
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-0339
Mailing Address - Country:US
Mailing Address - Phone:562-906-5227
Mailing Address - Fax:562-906-6450
Practice Address - Street 1:10200 PIONEER BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6000
Practice Address - Country:US
Practice Address - Phone:562-906-5227
Practice Address - Fax:562-906-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 10371291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB76459FMedicaid
CACLF 10371OtherCLINICAL LABORATORY LIC
CA05D0866459OtherCLIA NUMBER
CACLF 10371OtherCLINICAL LABORATORY LIC