Organization
INNOVATIVE GENOMICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIEGO SANCHEZ SANUDO CHOCRON (CFO)
(310) 985-2834
Entity
Organization
Contact information
Practice address
5410 FREDERICKSBURG RD, SUITE 304, SAN ANTONIO, TX 78229
(210) 352-5175
Mailing address
5410 FREDERICKSBURG RD STE 304, SAN ANTONIO, TX 78229-3576
(210) 351-5175
(210) 352-5175
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2155835
CLIA
TX
Enumeration date
04/06/2019
Last updated
05/20/2020
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