Organization
ALTHEADX, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID NIKODEM (CEO)
(858) 224-7200
Entity
Organization
Contact information
Practice address
3030 BUNKER HILL ST STE 300, SAN DIEGO, CA 92109-5754
(858) 224-7200
(858) 569-0708
Mailing address
3030 BUNKER HILL ST STE 300, SAN DIEGO, CA 92109-5754
(858) 224-7200
(858) 569-0708
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1093224
FEDERAL CLIA ID
—
01
—
CLF 00337547
CLINICAL LABORATORY LICENSE
CA
Enumeration date
08/05/2013
Last updated
05/01/2020
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