Organization
EXAGEN INC.
Active
Other names
Exagen Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
NIKKI KILLINGS (DIRECTOR OF OPERATIONS)
(760) 539-3031
Entity
Organization
Contact information
Practice address
1261 LIBERTY WAY STE C, VISTA, CA 92081-8356
(888) 452-1522
(760) 479-6486
Mailing address
PO BOX 27561, ALBUQUERQUE, NM 87125-7561
(888) 452-1522
(760) 479-6486
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 00334804
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1075048
CLIA
—
01
—
1484
MARYLAND DEPT OF HEALTH
MD
01
—
31066
PENNSYLVANIA DEPT OF HEALTH
PA
01
—
8369
NEW YORK STATE DEPARTMENT OF HEALTH
NY
01
—
CDF-00334804
CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE
CA
01
—
LCO00685
RHODE ISLAND DEPT OF HEALTH
RI
01
—
ZZZ555113Y
BLUE SHIELD OF CALIFORNIA
—
Enumeration date
07/15/2008
Last updated
02/08/2024
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