1326407636 NPI number — PACIFIC GENOMICS, LLC

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 1326407636 NPI number — PACIFIC GENOMICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC GENOMICS, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1326407636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 TECHNOLOGY DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-2364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-826-8274
Provider Business Mailing Address Fax Number:
949-783-5302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 TECHNOLOGY DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-826-8274
Provider Business Practice Location Address Fax Number:
949-783-5302
Provider Enumeration Date:
02/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LAMB
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
AUGUSTUS
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
480-352-1206

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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