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General NPI Number Information
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NPI Number | 1427776582
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Entity Type | Organization
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Legal Business Name | ESOTERIX GENETIC LABORATORIES, LLC
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 5607 W CAVEDALE DR
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City | PHOENIX
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State | AZ
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Zip | 85083-6374
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Country | US
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Telephone | 480-908-3992
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2240
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City | BURLINGTON
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State | NC
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Zip | 27216-2240
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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 | VICE PRESIDENT
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Name | KIMBERLY T WILLIAMS
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Credential |
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Telephone | 336-436-5761
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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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