1184874703 NPI number — LABORATORY FOR PERSONALIZED MOLECULAR MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184874703 NPI number — LABORATORY FOR PERSONALIZED MOLECULAR MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORY FOR PERSONALIZED MOLECULAR MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LABPMM
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184874703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10222 BARNES CANYON RD BLDG 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-224-6650
Provider Business Mailing Address Fax Number:
858-224-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10222 BARNES CANYON RD BLDG 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-224-6650
Provider Business Practice Location Address Fax Number:
858-224-6655
Provider Enumeration Date:
09/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
THORNES
Authorized Official First Name:
JORDAN
Authorized Official Middle Name:
LIEF
Authorized Official Title or Position:
GLOBAL DIRECTOR
Authorized Official Telephone Number:
858-224-6650

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 336024 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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