Organization
EPICGENETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE S GILLIS M.D., M.P.H. (PRESIDENT)
(310) 268-1001
Entity
Organization
Contact information
Practice address
11801 W OLYMPIC BLVD, LOS ANGELES, CA 90064-1114
(310) 268-1001
(310) 268-1015
Mailing address
11801 W OLYMPIC BLVD, LOS ANGELES, CA 90064-1114
(310) 268-1001
(310) 552-1940
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 00343424
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CLF00343424
CLIA
CA
Enumeration date
08/12/2014
Last updated
02/06/2019
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