Healthcare Provider Details

I. General information

NPI: 1427823905
Provider Name (Legal Business Name): ACHIEVE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 TANSY ST STE 101A
SAN DIEGO CA
92121-1550
US

IV. Provider business mailing address

8156 ROUTE 237
LE ROY NY
14482-9324
US

V. Phone/Fax

Practice location:
  • Phone: 619-314-5883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES PARKS
Title or Position: MEMBER
Credential:
Phone: 760-846-4578