Organization
GENOMIC TESTING COOPERATIVE LCA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE ECK (COO)
(657) 202-5951
Entity
Organization
Contact information
Practice address
25371 COMMERCENTRE DR, LAKE FOREST, CA 92630-8859
(949) 540-9421
(949) 301-9719
Mailing address
25371 COMMERCENTRE DR, LAKE FOREST, CA 92630-8859
(657) 202-5951
(949) 301-9719
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2111917
CLIA
—
Enumeration date
01/07/2019
Last updated
06/28/2024
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