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General NPI Number Information
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NPI Number | 1306558044
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Entity Type | Organization
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Legal Business Name | MILAGEN, INC.
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 1255 PARK AVE STE B
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City | EMERYVILLE
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State | CA
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Zip | 94608-3679
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Country | US
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Telephone | 510-597-1244
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 PARK AVE STE B
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City | EMERYVILLE
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State | CA
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Zip | 94608-3679
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS & COMPLIANCE
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Name | DR. CHRISTINE CHAVANY
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Credential | PHD, RAC
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Telephone | 510-597-1244
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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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