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General NPI Number Information
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NPI Number | 1699432344
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Entity Type | Organization
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Legal Business Name | MEDICAL GENETICS DIAGNOSTIC CENTER LLC
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 11160 WARNER AVE STE 201
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4048
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Country | US
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Telephone | 714-540-0105
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Fax | 714-540-6727
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Provider Business Mailing Address
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Address Line | 11160 WARNER AVE STE 201
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4048
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Country | US
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Telephone | 714-540-0105
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Fax | 714-540-6727
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Authorized Official
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Title or Position | PHYSICIAN/MANAGER
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Name | DR. XUANTO LEDUC
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Credential | MD
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Telephone | 714-540-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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