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General NPI Number Information
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NPI Number | 1184874703
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Entity Type | Organization
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Legal Business Name | LABORATORY FOR PERSONALIZED MOLECULAR MEDICINE
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 10222 BARNES CANYON RD BLDG 1
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City | SAN DIEGO
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State | CA
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Zip | 92121-2711
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Country | US
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Telephone | 858-224-6650
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Fax | 858-224-6655
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Provider Business Mailing Address
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Address Line | 10222 BARNES CANYON RD BLDG 1
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City | SAN DIEGO
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State | CA
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Zip | 92121-2711
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Country | US
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Telephone | 858-224-6650
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Fax | 858-224-6655
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Authorized Official
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Title or Position | GLOBAL DIRECTOR
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Name | MR. JORDAN LIEF THORNES
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Credential |
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Telephone | 858-224-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF 336024
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License Number State | CA
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