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General NPI Number Information
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NPI Number | 1992087654
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Entity Type | Organization
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Legal Business Name | DIABETOMICS, INC.
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 2345 NW AMBERBROOK DR SUITE 140
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City | HILLSBORO
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State | OR
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Zip | 97006-6972
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Country | US
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Telephone | 503-924-5110
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Fax | 503-924-5111
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Provider Business Mailing Address
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Address Line | 2345 NW AMBERBROOK DR SUITE 140
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City | HILLSBORO
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State | OR
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Zip | 97006-6972
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Country | US
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Telephone | 503-924-5110
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Fax | 503-924-5111
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Authorized Official
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Title or Position | DIRECTOR OF LABORATORY
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Name | DR. STEVEN KAZMIERCZAK
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Credential | PH.D.
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Telephone | 503-924-5110
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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 | 38D2018569
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License Number State | OR
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