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General NPI Number Information
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NPI Number | 1467783753
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Entity Type | Organization
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Legal Business Name | MATRIX GENOMICS, INC.
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 3900 PASEO DEL SOL
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City | SANTA FE
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State | NM
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Zip | 87507-4072
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Country | US
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Telephone | 505-216-0660
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Fax | 505-216-1144
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Provider Business Mailing Address
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Address Line | 3900 PASEO DEL SOL
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City | SANTA FE
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State | NM
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Zip | 87507-4072
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Country | US
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Telephone | 505-216-0660
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Fax | 505-216-1144
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Authorized Official
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Title or Position | CEO
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Name | DR. LARRY STEWART CORDER
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Credential | PH.D.
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Telephone | 505-216-0660
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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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