MEDICARE: SEQUENOM CENTER FOR MOLECULAR MEDICINE 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	CLF00339964	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
49	FV093A	OTHER	CA	MEDICARE PTAN

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
2	05D2015356	OTHER	CA	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1728	OTHER	MD	MARYLAND MEDICAL LABORATORY PERMIT
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	800026127	OTHER	FL	STATE OF FLORIDA CLINICAL LABORATORY LICENSE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	7527138	OTHER		COLLEGE OF AMERICAN PATHOLOGISTS (CAP)
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	032136	OTHER	PA	STATE OF PENNSYLVANIA CLINICAL LABORATORY LICENSE
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23	PFI: 8557	OTHER	NY	STATE OF NEW YORK CLINICAL LABORATORY PERMIT
24	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
26	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
29	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
32	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33	CLF00339964	OTHER	CA	CLINICAL LABORATORY LICENSE
34	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
35	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
36	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
37	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
39	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
40	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
43	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
44	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
45	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
46	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
47	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
48	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
50	LCO 00657	OTHER	RI	RHODE ISLAND CLINICAL LABORATORY LICENSE

General Provider Information

NPI Number	:	1730481078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC

Provider Business Mailing Address
First Line	:	3595 JOHN HOPKINS CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1121
Country	:	US
Telephone Number	:	858-202-9051
Fax Number	:	858-408-7847

Provider Business Practice Location Address
First Line	:	3595 JOHN HOPKINS CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1121
Country	:	US
Telephone Number	:	858-202-9051
Fax Number	:	858-408-7847

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIMBERLY T WILLIAMS
Credential	:
Telephone Number	:	800-222-7566

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	07/20/2017

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