Organization
ESOTERIX GENETIC LABORATORIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY WILLIAMS (VP)
(800) 222-7566
Entity
Organization
Contact information
Practice address
2440 S SEPULVEDA BLVD, STE 100, LOS ANGELES, CA 90064-1784
(310) 689-0610
Mailing address
PO BOX 2240, BURLINGTON, NC 27216-2240
(800) 222-7566
(336) 436-5153
Taxonomy
Speciality
Code
Description
License number
State
261QG0250X
Genetics Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0907763
CLIA
—
Enumeration date
11/16/2010
Last updated
01/02/2014
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