Provider Demographics
NPI:1124395165
Name:GENOMIC EXPRESS, INC.
Entity Type:Organization
Organization Name:GENOMIC EXPRESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BITTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-495-7515
Mailing Address - Street 1:725 LAKEFIELD RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2615
Mailing Address - Country:US
Mailing Address - Phone:805-495-7515
Mailing Address - Fax:805-495-1866
Practice Address - Street 1:725 LAKEFIELD RD
Practice Address - Street 2:SUITE H
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2615
Practice Address - Country:US
Practice Address - Phone:805-495-7515
Practice Address - Fax:805-495-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00340403291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory