Provider Demographics
NPI:1063481570
Name:CELLNETIX LABS LLC
Entity Type:Organization
Organization Name:CELLNETIX LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:206-386-2676
Mailing Address - Street 1:PO BOX 94344
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6644
Mailing Address - Country:US
Mailing Address - Phone:206-386-2676
Mailing Address - Fax:206-386-2709
Practice Address - Street 1:1321 COLBY AVENUE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98206
Practice Address - Country:US
Practice Address - Phone:425-261-3670
Practice Address - Fax:425-261-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7129968Medicaid
WAG8857157Medicare PIN
WA7129968Medicaid