Organization
SIMPLIFY GENOMICS CLINICAL LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS LACEY (CHIEF EXECUTIVE OFFICER)
(847) 668-8090
Entity
Organization
Contact information
Practice address
440 STEVENS AVENUE, SUITE 200, SOLANA BEACH, CA 92075
(847) 668-8090
(888) 443-4153
Mailing address
440 STEVENS AVENUE, SUITE 200, SOLANA BEACH, CA 92075
(847) 668-8090
(888) 443-4153
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2167801
CLIA
CA
01
—
CLF-00353852
CDPH CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE
CA
Enumeration date
02/01/2017
Last updated
01/09/2024
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