# INFORM DIAGNOSTICS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** INFORM DIAGNOSTICS, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710782388
- **Legal business name:** INFORM DIAGNOSTICS, INC.
- **Authorized official:** RAYMOND CHRISTOPHER WICKER (VP, GENERAL MANAGER)
- **Authorized official phone:** (678) 477-4402

## Contact information

- **Practice address:** 827 GROVE VIEW RD, OCEANSIDE, CA 92057-2202
- **Practice address phone:** (888) 290-5307
- **Mailing address:** 1111 S FREEPORT PKWY, COPPELL, TX 75019-4435
- **Mailing address phone:** (888) 290-5307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |

## Other

- **Enumeration date:** 02/17/2025
- **Last updated:** 02/17/2025