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General NPI Number Information
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NPI Number | 1649408840
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Entity Type | Organization
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Legal Business Name | MEDOMICS, LLC
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 426 N SAN GABRIEL AVE
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City | AZUSA
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State | CA
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Zip | 91702-3451
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Country | US
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Telephone | 626-804-3645
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Fax | 626-804-3648
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Provider Business Mailing Address
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Address Line | 426 N. SAN GABRIEL AVENUE
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City | AZUSA
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State | CA
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Zip | 91102
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Country | US
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Telephone | 626-804-3645
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Fax | 626-804-3648
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. STEVE SOMMER
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Credential | M.D., PH.D.
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Telephone | 626-804-3645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 7216791
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License Number State | CA
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