1861568784 NPI number — AMBRY GENETICS CORPORATION

Table of content: (NPI 1861568784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861568784 NPI number — AMBRY GENETICS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBRY GENETICS CORPORATION
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:
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:
1861568784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 51458
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91761-1048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-900-5500
Provider Business Mailing Address Fax Number:
949-900-5501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 ARGONAUT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALISO VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92656-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-900-5500
Provider Business Practice Location Address Fax Number:
949-900-5501
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
949-900-5585

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF11694 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , 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)

  • Identifier: 775960 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAB81414F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1017246 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1517245 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212446301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212446302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2958381 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690000008 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 69584834 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003151337A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15197 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2418146 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0054976 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1024063580001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010127904 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200967250A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 157113709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200034590A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806650800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0421379 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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