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General NPI Number Information
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NPI Number | 1265036610
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Entity Type | Organization
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Legal Business Name | MICRONOMA INC.
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 6342 FERRIS SQ
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City | SAN DIEGO
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State | CA
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Zip | 92121-3207
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Country | US
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Telephone | 858-353-7016
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Fax |
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Provider Business Mailing Address
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Address Line | 6342 FERRIS SQ
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City | SAN DIEGO
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State | CA
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Zip | 92121-3207
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Country | US
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Telephone | 858-241-1318
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SANDRINE MILLER-MONTGOMERY
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Credential |
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Telephone | 858-353-7016
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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 |
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License Number State |
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