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General NPI Number Information
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NPI Number | 1912684929
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Entity Type | Organization
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Legal Business Name | INTEGRATED MOLECULAR DIAGNOSTICS PATHOLOGY, INC.
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 4150 TRUXEL RD STE C
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City | SACRAMENTO
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State | CA
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Zip | 95834-3761
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Country | US
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Telephone | 510-849-6189
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 TELEGRAPH AVE STE 203
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City | BERKELEY
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State | CA
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Zip | 94705-1153
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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 | CHIEF OPERATING OFFICER
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Name | ISRAEL VILLASENOR
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Credential |
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Telephone | 831-818-4051
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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 |
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