Provider Demographics
NPI:1588915300
Name:ADVANCED DIAGNOSTIC SOLUTIONS INC.
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-293-2810
Mailing Address - Street 1:1900 S NORFOLK ST STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1171
Mailing Address - Country:US
Mailing Address - Phone:352-293-2810
Mailing Address - Fax:727-264-2117
Practice Address - Street 1:1900 S NORFOLK ST
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1164
Practice Address - Country:US
Practice Address - Phone:352-293-2810
Practice Address - Fax:352-274-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory