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1265854855 NPI number — GENETIC TECHNOLOGICAL INNOVATIONS, LLC

NPI Number: 1265854855
Health Care Provider/Practitioner: GENETIC TECHNOLOGICAL INNOVATIONS, LLC

Information about “1265854855” NPI (GENETIC TECHNOLOGICAL INNOVATIONS, LLC) exists in 1265854855 in HTML format HTML  |  1265854855 in plain Text format TXT  |  1265854855 in PDF (Portable Document Format) PDF  |  1265854855 in an XML format XML  formats.

NPI Number : 1265854855 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265854855",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GENETIC TECHNOLOGICAL INNOVATIONS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "14500 N NORTHSIGHT BLVD STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SCOTTSDALE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85260-3659",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "877-993-2484",
    "MailingAddressFaxNumber": "480-265-4453",
    "FirstLinePracticeLocationAddress": "13402 N SCOTTSDALE RD STE 190",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SCOTTSDALE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85254-4054",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "480-674-6565",
    "PracticeLocationAddressFaxNumber": "480-265-4453",
    "EnumerationDate": "01/15/2014",
    "LastUpdateDate": "10/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GLIMCHER",
    "AuthorizedOfficialFirstName": "NICHOLAS",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "480-476-8761",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": "05D2071616",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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