Organization
CCRM SAN FRANCISCO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON PARDEW (CEO)
(303) 968-1950
Entity
Organization
Contact information
Practice address
1060 MARSH RD FL 1, MENLO PARK, CA 94025-1020
(650) 646-7500
Mailing address
9380 STATION ST STE 425, LONE TREE, CO 80124-6832
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D2139767
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2139767
CLIA
—
Enumeration date
08/23/2018
Last updated
08/23/2018
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