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General NPI Number Information
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NPI Number | 1356123418
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Entity Type | Organization
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Legal Business Name | LINEAGEN, INC.
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 6777 NANCY RIDGE DR
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City | SAN DIEGO
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State | CA
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Zip | 92121-2231
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Country | US
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Telephone | 858-888-7600
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Fax | 858-888-7601
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Provider Business Mailing Address
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Address Line | 6777 NANCY RIDGE DR
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City | SAN DIEGO
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State | CA
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Zip | 92121-2231
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Country | US
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Telephone | 801-931-6200
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Fax | 801-931-6201
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROBERT ERIK HOLMLIN
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Credential |
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Telephone | 858-349-4995
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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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