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General NPI Number Information
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NPI Number | 1689818627
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Entity Type | Organization
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Legal Business Name | PATHWAY GENOMICS CORPORATION
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 4755 NEXUS CENTER DRIVE
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-450-6600
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Fax | 858-866-9751
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Provider Business Mailing Address
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Address Line | 4755 NEXUS CENTER DR
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City | SAN DIEGO
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State | CA
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Zip | 92121-3051
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Country | US
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Telephone | 858-450-6600
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Fax | 858-866-9751
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Authorized Official
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Title or Position | CEO
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Name | VADIM SHULMAN
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Credential |
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Telephone | 858-450-6600
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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 | CLF 338038
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License Number State | CA
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