Provider Demographics
NPI:1538319066
Name:REPROGENETICS CALIFORNIA
Entity Type:Organization
Organization Name:REPROGENETICS CALIFORNIA
Other - Org Name:GENESIS GENETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-601-9808
Mailing Address - Street 1:75 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1350
Mailing Address - Country:US
Mailing Address - Phone:203-601-5200
Mailing Address - Fax:973-992-1423
Practice Address - Street 1:11500 W. OLYMPIC BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-231-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER GENOMICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-20
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA099499291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory