ESOTERIX GENETIC LABORATORIES, LLC (NPI# 1922309376) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922309376 |
| Entity Type | Organization |
| Organization Name | ESOTERIX GENETIC LABORATORIES, LLC |
| Practice Address |
17772 17th St Suite 200 Room 217 Tustin CA 92780-1944 |
| Mailing Address |
Po Box 2240 Burlington NC 27216-2240 |
| Practice Telephone | 8007101800 |
| Mailing Telephone | 8002227566 |
| Mailing Fax Number | 3364361048 |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2016-06-24 |
| Authorized Official Name | KIMBERLY T WILLIAMS (VP) |
| Authorized Official Telephone | 8002227566 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CLIA | 05D0642715 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124536107 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 3 Forest Pkwy, Shelton, CT 06484-6122 | 2018-01-12 |
| 1659672004 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 533 W 57th St, New York, NY 10019-2901 | 2010-11-16 |
| 1043511496 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 12906 Tampa Oaks Blvd, Ste 300, Temple Terrace, FL 33637-1153 | 2010-11-16 |
| 1588965941 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 8300 Old Courthouse Rd Ste 240, Vienna, VA 22182-3822 | 2010-11-16 |
| 1467753814 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 4310 E Cotton Center Blvd Ste 120, Phoenix, AZ 85040-8857 | 2010-11-16 |
| 1649572017 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 3400 Computer Dr, Westborough, MA 01581-1771 | 2010-11-17 |
| 1679874028 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 1054 W Town and Country Rd, Orange, CA 92868-4716 | 2010-11-16 |
| 1801197256 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 2000 Vivigen Way, Santa Fe, NM 87505-5600 | 2010-11-16 |
| 1023319407 | Esoterix Genetic Laboratories, LLC | Clinic/Center | 2440 S Sepulveda Blvd, Ste 100, Los Angeles, CA 90064-1784 | 2010-11-16 |
| 1689975021 | Esoterix Genetic Laboratories, LLC | Clinical Medical Laboratory | 3400 Computer Dr, Westborough, MA 01581-1771 | 2010-11-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ESOTERIX GENETIC LABORATORIES, LLC | 3400 Computer Dr, Westborough, MA 01581-1771 |
| Colorado Business Entities | Esoterix Genetic Laboratories, LLC | 531 South Spring Street, Burlington, NC 27215 |
| Massachusetts Corporations | ESOTERIX GENETIC LABORATORIES, LLC | 231 Maple Avenue, Burlington, NC 27215 |
| Ohio Business Entities | ESOTERIX GENETIC LABORATORIES, LLC | 358 South Main Street, Burlington, NC 27215 |
| Street Address |
17772 17TH ST SUITE 200 ROOM 217 |
| City | TUSTIN |
| State | CA |
| Zip Code | 92780-1944 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427035799 | Accupath Diagnostic Laboratories, Inc | Clinical Medical Laboratory | 17772 17th St, Suite 101, Tustin, CA 92780-1944 | 2005-12-28 |
| 1922202027 | Eric Wayne Gruver X | Psychologist | 17772 17th St, Ste 106, Tustin, CA 92780-1944 | 2007-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437780947 | John Michael Michael | Pharmacist | 14481 Wildeve Ln, Tustin, CA 92780 | 2020-02-03 |
| 1609426881 | Abigail Joy Maqsood | Behavior Technician | 290a S Prospect Ave, Tustin, CA 92780 | 2019-09-19 |
| 1255814711 | Hyun Dong Lee | Chiropractor | 14591 Newport Ave Ste 106, Tustin, CA 92780 | 2018-09-11 |
| 1346733573 | Elizabeth Kim Nguyen Dds Inc | Clinic/Center | 14521 Red Hill Ave, Tustin, CA 92780 | 2018-06-12 |
| 1255829503 | Hw Physical Therapy | Physical Therapist | 250 El Camino Real Ste 100, Tustin, CA 92780 | 2018-04-23 |
| 1912494352 | Gary Wayne Mcbeath | Marriage & Family Therapist | 17821 E 17th Street, Suite # 260, Tustin, CA 92780 | 2018-04-20 |
| 1104334598 | Catherine Bogues | Speech-Language Pathologist | 661 West 1st Street, Suite E, Tustin, CA 92780 | 2018-01-19 |
| 1972019941 | Lighthouse Behavioral Solutions | Behavioral Analyst | 18002 Irvine Blvd., Suite 202c, Tustin, CA 92780 | 2017-12-28 |
| 1629597299 | Lifecab, LLC | Non-emergency Medical Transport (VAN) | 13732 Newport Ave, Suite #1, Tustin, CA 92780 | 2017-09-14 |
| 1437606555 | Tustin Speech Therapy, Inc. | Speech-Language Pathologist | 661 West First Street, Suite E, Tustin, CA 92780 | 2016-09-07 |
| Find all providers in zip 92780 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598138562 | Equaltox, LLC | Clinical Medical Laboratory | 1562 Parkway Loop, Suite B, Tustin, CA 92780-6507 | 2015-11-12 |
| 1699085290 | Histopathology Services Inc | Clinical Medical Laboratory | 15012 Red Hill Ave, Suite 8h, Tustin, CA 92780-6524 | 2010-10-15 |
| 1528387727 | Labwest, Inc | Clinical Medical Laboratory | 100 N Tustin Ave, Tustin, CA 92780-2908 | 2010-05-27 |
| 1326234204 | Mohs-tek, Inc. | Clinical Medical Laboratory | 1342 Bell Ave Ste 3h, Tustin, CA 92780-6440 | 2007-09-24 |
| 1861566762 | Jamellow LLC | Clinical Medical Laboratory | 1131 E Main St, Suite 109, Tustin, CA 92780-4416 | 2006-11-20 |
| 1750494209 | Oncotech Inc | Clinical Medical Laboratory | 15501 Red Hill Avenue, Tustin, CA 92780 | 2006-08-17 |
| 1487686556 | Hooshang Dalavarian, Inc | Clinical Medical Laboratory | 100 Tustin Ave, Tustin, CA 92780 | 2006-07-07 |
| 1427035799 | Accupath Diagnostic Laboratories, Inc | Clinical Medical Laboratory | 17772 17th St, Suite 101, Tustin, CA 92780-1944 | 2005-12-28 |
| 1003810409 | Harris Histology Services | Clinical Medical Laboratory | 630 S B St, Tustin, CA 92780-4318 | 2005-06-13 |
| 1235132846 | Accupath Diagnostic Laboratories, Inc | Clinical Medical Laboratory | 17772 17th St # 101-106, Tustin, CA 92780-1944 | 2005-05-27 |
| Find all providers in TUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.