Provider Demographics
NPI:1043737505
Name:PRECISION TOXICOLOGY, LLC
Entity Type:Organization
Organization Name:PRECISION TOXICOLOGY, LLC
Other - Org Name:PRECISION DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-635-6901
Mailing Address - Street 1:6755 MIRA MESA BLVD STE 123-153
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4392
Mailing Address - Country:US
Mailing Address - Phone:800-635-6901
Mailing Address - Fax:858-228-9909
Practice Address - Street 1:49 STATE RD STE 103N
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3303
Practice Address - Country:US
Practice Address - Phone:800-635-6901
Practice Address - Fax:858-228-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5434OtherCLINICAL LAB LICENSE
MA22D2133197OtherCLIA REGISTRATION
MA110129278AMedicaid