Organization
RENEGADEXBIO, PBC
Active
Other names
Renegade.Bio
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG ROUSKEY MS (CEO)
(415) 338-9306
Entity
Organization
Contact information
Practice address
829 HEINZ AVE, BERKELEY, CA 94710-2754
(415) 338-9306
(415) 329-7843
Mailing address
829 HEINZ AVE, BERKELEY, CA 94710-2754
(415) 338-9306
(415) 329-7843
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2185960
CLIA
—
01
—
CDF-90000924
STATE ID
CA
Enumeration date
05/21/2020
Last updated
06/15/2022
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