Provider Demographics
NPI:1386708816
Name:APPLIED CLINICAL RESEARCH
Entity type:Organization
Organization Name:APPLIED CLINICAL RESEARCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-677-7970
Mailing Address - Street 1:6565 NANCY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2251
Mailing Address - Country:US
Mailing Address - Phone:858-677-7970
Mailing Address - Fax:858-677-7998
Practice Address - Street 1:6565 NANCY RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-677-7970
Practice Address - Fax:858-677-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 4838291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32942000Medicaid
NC7001273Medicaid
CALAB42965GMedicaid
WI32942000Medicaid