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General NPI Number Information
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NPI Number | 1972829752
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Entity Type | Organization
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Legal Business Name | CYNOGEN, INC.
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 09/14/2017
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Provider Practice Location Address
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Address Line | 25901 COMMERCENTRE DR
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City | LAKE FOREST
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State | CA
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Zip | 92630-8805
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Country | US
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Telephone | 877-429-6643
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Fax | 949-587-7502
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Provider Business Mailing Address
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Address Line | 25901 COMMERCENTRE DR
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City | LAKE FOREST
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State | CA
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Zip | 92630-8805
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Country | US
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Telephone | 877-429-6643
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Fax | 949-587-7502
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Authorized Official
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Title or Position | OFFICE ADMIN
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Name | MS. HALLIE A STOHLER
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Credential |
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Telephone | 949-587-7516
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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 | CA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF00339441
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License Number State | CA
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