Provider Demographics
NPI:1114319563
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:
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
Mailing Address - Street 2:SUITE 123-153
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 1:836 FARMINGTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1505
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:2015-02-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1114319563Medicaid