Provider Demographics
NPI:1114332632
Name:FREQUENCY GENOMICS, LLC
Entity Type:Organization
Organization Name:FREQUENCY GENOMICS, LLC
Other - Org Name:VANTARI GENETICS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:OSWALD
Authorized Official - Last Name:WEILBAECHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-536-6070
Mailing Address - Street 1:27 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2364
Practice Address - Country:US
Practice Address - Phone:949-783-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory