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General NPI Number Information
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NPI Number | 1265854855
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Entity Type | Organization
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Legal Business Name | GENETIC TECHNOLOGICAL INNOVATIONS, LLC
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 13402 N SCOTTSDALE RD STE 190
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-4054
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Country | US
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Telephone | 480-674-6565
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Fax | 480-265-4453
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Provider Business Mailing Address
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Address Line | 14500 N NORTHSIGHT BLVD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3659
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Country | US
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Telephone | 877-993-2484
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Fax | 480-265-4453
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Authorized Official
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Title or Position | CEO
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Name | NICHOLAS GLIMCHER
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Credential |
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Telephone | 480-476-8761
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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 | 05D2071616
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License Number State | CA
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