Healthcare Provider Details

I. General information

NPI: 1205744943
Provider Name (Legal Business Name): AMERICAN GENOMICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 GRAND CANAL BLVD STE 101
STOCKTON CA
95207-8138
US

IV. Provider business mailing address

2453 GRAND CANAL BLVD STE 101
STOCKTON CA
95207-8138
US

V. Phone/Fax

Practice location:
  • Phone: 818-325-9633
  • Fax:
Mailing address:
  • Phone: 818-325-9633
  • Fax:

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: SVETLANA SHABDEEN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 818-325-9633