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General NPI Number Information
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NPI Number | 1528754603
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Entity Type | Organization
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Legal Business Name | GENOME-BASED DIAGNOSTICS
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 6064 CORTE DEL CEDRO STE B
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City | CARLSBAD
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State | CA
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Zip | 92011-1514
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Country | US
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Telephone | 760-487-8235
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Fax |
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Provider Business Mailing Address
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Address Line | 2091 LAS PALMAS DR STE A
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City | CARLSBAD
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State | CA
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Zip | 92011-1551
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Country | US
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Telephone | 760-487-8235
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS CRISMAN
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Credential | PHD, MS
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Telephone | 831-295-3272
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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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