Healthcare Provider Details

I. General information

NPI: 1467783753
Provider Name (Legal Business Name): MATRIX GENOMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PASEO DEL SOL
SANTA FE NM
87507-4072
US

IV. Provider business mailing address

3900 PASEO DEL SOL
SANTA FE NM
87507-4072
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-0660
  • Fax: 505-216-1144
Mailing address:
  • Phone: 505-216-0660
  • Fax: 505-216-1144

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. LARRY STEWART CORDER
Title or Position: CEO
Credential: PH.D.
Phone: 505-216-0660