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General NPI Number Information
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NPI Number | 1710392535
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Entity Type | Organization
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Legal Business Name | RETROGEN INC
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 6645 NANCY RIDGE DR
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City | SAN DIEGO
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State | CA
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Zip | 92121-2253
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Country | US
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Telephone | 858-455-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 6645 NANCY RIDGE DR
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City | SAN DIEGO
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State | CA
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Zip | 92121-2253
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Country | US
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Telephone | 858-455-8411
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. VINCENT VU
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Credential |
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Telephone | 858-455-8411
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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 | CLF00342957
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License Number State | CA
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