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General NPI Number Information
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NPI Number | 1710891239
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Entity Type | Organization
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Legal Business Name | ESOTERIX, INC.
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 112 S LAKEVIEW CANYON RD STE 130
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-3942
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Country | US
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Telephone | 818-880-8040
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2240
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City | BURLINGTON
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State | NC
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Zip | 27216-2240
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | EVAN T SMITH
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Credential |
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Telephone | 336-209-8960
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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 |
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License Number State | NULL
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