1902865868 NPI number — MONOGRAM BIOSCIENCES, INC

Table of content: (NPI 1902865868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902865868 NPI number — MONOGRAM BIOSCIENCES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONOGRAM BIOSCIENCES, INC
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:
1902865868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 OYSTER POINT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94080-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-635-1100
Provider Business Mailing Address Fax Number:
888-369-0023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 OYSTER POINT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94080-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-635-1100
Provider Business Practice Location Address Fax Number:
888-369-0023
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
800-222-7566

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF11444 , 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: LAB41934F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030676200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4424050 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02084866 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8404909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113026900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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