MEDICARE: DNAFEED INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207SG0203X	Clinical Molecular Genetics Physician
2	261QG0250X	Genetics Clinic/Center
3	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1518428119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNAFEED INC

Provider Business Mailing Address
First Line	:	13423 MORETON GLN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-1421
Country	:	US
Telephone Number	:	650-785-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	13423 MORETON GLN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-1421
Country	:	US
Telephone Number	:	650-785-2060
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AHMED EL KALLINY
Credential	:
Telephone Number	:	650-785-2060

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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Directions to “DNAFEED INC ” Practice Location

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