Healthcare Provider Details

I. General information

NPI: 1730642208
Provider Name (Legal Business Name): PROMOLECULAR DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 ALFRED NOBEL DR
HERCULES CA
94547-1805
US

IV. Provider business mailing address

712 ALFRED NOBEL DR
HERCULES CA
94547-1805
US

V. Phone/Fax

Practice location:
  • Phone: 106-625-2145
  • Fax:
Mailing address:
  • Phone: 510-662-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HILL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 707-315-3455