Provider Demographics
NPI:1346713989
Name:GENOMIC TESTING COOPERATIVE LCA
Entity Type:Organization
Organization Name:GENOMIC TESTING COOPERATIVE LCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-202-5951
Mailing Address - Street 1:175 TECHNOLOGY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2473
Mailing Address - Country:US
Mailing Address - Phone:657-202-5951
Mailing Address - Fax:949-301-9719
Practice Address - Street 1:25371 COMMERCENTRE DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8859
Practice Address - Country:US
Practice Address - Phone:949-540-9421
Practice Address - Fax:949-301-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D2111917OtherCLIA