Organization
PROMETHEUS LABORATORIES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA VASQUEZ (SVP, COMMERCIAL AND CORP. DEVELOPME)
(858) 587-4128
Entity
Organization
Contact information
Practice address
9410 CARROLL PARK DR, SAN DIEGO, CA 92121-5201
(858) 824-0895
(858) 824-0896
Mailing address
9410 CARROLL PARK DR, SAN DIEGO, CA 92121-5201
(858) 824-0895
(858) 824-0896
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D0917432
CA
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162505709
—
AR
05
—
LAB17432F
—
CA
01
—
ZZZ59192Z
BLUE SHIELD
—
Enumeration date
03/02/2007
Last updated
06/21/2023
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