Healthcare Provider Details

I. General information

NPI: 1790333227
Provider Name (Legal Business Name): DISCOVERY GENOMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 THEORY STE 150
IRVINE CA
92617-3028
US

IV. Provider business mailing address

2260 UNIVERSITY DR
NEWPORT BEACH CA
92660-3319
US

V. Phone/Fax

Practice location:
  • Phone: 714-980-1011
  • Fax:
Mailing address:
  • Phone: 949-220-1702
  • Fax: 949-220-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. SANJAY PATIL
Title or Position: CEO
Credential: MD
Phone: 714-980-0128