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General NPI Number Information
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NPI Number | 1609483510
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Entity Type | Organization
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Legal Business Name | SKYLINEDX USA INC.
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 3030 BUNKER HILL ST STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92109-5757
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Country | US
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Telephone | 858-886-7907
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 BUNKER HILL ST STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92109-5757
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Country | US
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Telephone | 858-886-7907
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VP, FINANCE, HR & LEGAL
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Name | MR. PIM VAN BRUGGEN
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Credential | MBA
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Telephone | 10-720-0313
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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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