Healthcare Provider Details

I. General information

NPI: 1841015575
Provider Name (Legal Business Name): GENOMAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 12/05/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 GERBERA STREET (OPTIONAL)
DANVILLE CA
94506-4790
US

IV. Provider business mailing address

104 GERBERA STREET (OPTIONAL)
DANVILLE CA
94506-4790
US

V. Phone/Fax

Practice location:
  • Phone: 503-709-5519
  • Fax:
Mailing address:
  • Phone: 503-709-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA NOEMI PEREZ PAZ
Title or Position: CEO
Credential:
Phone: 503-709-5519