MEDICARE: MULTIGEN DIAGNOSTICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	05D1094618	CA

General Provider Information

NPI Number	:	1710209853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTIGEN DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	11575 SORRENTO VALLEY RD
Second Line	:	SUITE # 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1319
Country	:	US
Telephone Number	:	858-523-1675
Fax Number	:	858-523-1677

Provider Business Practice Location Address
First Line	:	11575 SORRENTO VALLEY RD
Second Line	:	SUITE # 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1319
Country	:	US
Telephone Number	:	858-523-1675
Fax Number	:	858-523-1677

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. THURAIAYAH VINAYAGAMOORTHY
Credential	:	PH.D.
Telephone Number	:	858-523-1675

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	09/08/2011

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