MEDICARE: BIOTHERANOSTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	CALIFORNIA CFL334843	CA
2	291U00000X	Clinical Medical Laboratory	334843	CA
3	291U00000X	Clinical Medical Laboratory	CLIA 05D1065725	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043344435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOTHERANOSTICS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 749249
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-9249
Country	:	US
Telephone Number	:	877-886-6739
Fax Number	:	858-587-5871

Provider Business Practice Location Address
First Line	:	6333 SEQUENCE DRIVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4356
Country	:	US
Telephone Number	:	858-587-5870
Fax Number	:	858-587-5871

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN ROBERTS
Credential	:	M.D.
Telephone Number	:	858-587-5885

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	09/24/2025

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