MEDICARE: LIGERA LLC

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

General Provider Information

NPI Number	:	1659012003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGERA LLC

Provider Business Mailing Address
First Line	:	4907 MORENA BLVD STE 1405
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-7384
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 HARBISON AVE STE B
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3919
Country	:	US
Telephone Number	:	619-742-5633
Fax Number	:

Authorized Official
Title or Position	:	CHIEF SCIENTIFIC OFFICER
Name	:	WEI TSE LI
Credential	:
Telephone Number	:	626-922-9985

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/19/2022

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Directions to “LIGERA LLC ” Practice Location

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