Healthcare Provider Details

I. General information

NPI: 1114392933
Provider Name (Legal Business Name): FLEXOGENIX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21250 HAWTHORNE BLVD SUITE 110
TORRANCE CA
90503-5508
US

IV. Provider business mailing address

1000 S HOPE STREET SUITE 101
LOS ANGELES CA
90015-4057
US

V. Phone/Fax

Practice location:
  • Phone: 213-622-6010
  • Fax: 213-622-6011
Mailing address:
  • Phone: 213-622-6010
  • Fax: 213-622-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN PATRICK WHALEN
Title or Position: CBDO
Credential: M.D,
Phone: 213-622-6010