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General NPI Number Information
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NPI Number | 1639426281
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Entity Type | Organization
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Legal Business Name | SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 7010 KIT CREEK RD (PHYSICAL ONLY - NO USPS MAIL DELIVERY)
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City | MORRISVILLE
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State | NC
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Zip | 27560-9761
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Country | US
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Telephone | 858-202-9051
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Fax | 858-408-7847
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Provider Business Mailing Address
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Address Line | 3595 JOHN HOPKINS CT
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City | SAN DIEGO
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State | CA
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Zip | 92121-1121
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Country | US
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Telephone | 858-202-9051
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Fax | 858-408-7847
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIRK VAN DEN BOOM
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Credential | PHD
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Telephone | 858-202-9051
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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 | 34D2044309
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License Number State | NC
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