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General NPI Number Information
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NPI Number | 1366111841
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Entity Type | Organization
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Legal Business Name | DXOME CLIA LABORATORY, INC.
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 8871 RESEARCH DR
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City | IRVINE
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State | CA
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Zip | 92618-4236
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Country | US
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Telephone | 949-409-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 8871 RESEARCH DR
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City | IRVINE
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State | CA
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Zip | 92618-4236
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Country | US
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Telephone | 949-418-8998
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Fax | 949-418-8150
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | JAIME SHAMONKI
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Credential |
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Telephone | 310-486-1836
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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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