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General NPI Number Information
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NPI Number | 1134306541
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Entity Type | Organization
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Legal Business Name | ESOTERIX GENETIC LABORATORIES, LLC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 605 E HUNTINGTON DR STE 209
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City | MONROVIA
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State | CA
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Zip | 91016-6353
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Country | US
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Telephone | 626-471-7443
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Fax | 310-482-5204
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Provider Business Mailing Address
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Address Line | PO BOX 2270
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City | BURLINGTON
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State | NC
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Zip | 27216-2270
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Country | US
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Telephone | 800-222-7566
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Fax | 336-436-1048
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Authorized Official
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Title or Position | OFFICER
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Name | KIMBERLY T WILLIAMS
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Credential |
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Telephone | 800-222-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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