Provider Demographics
NPI:1598173502
Name:DERMTECH OPERATIONS, INC.
Entity Type:Organization
Organization Name:DERMTECH OPERATIONS, INC.
Other - Org Name:DERMTECH INTERNATIONAL, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-450-4222
Mailing Address - Street 1:12340 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3079
Mailing Address - Country:US
Mailing Address - Phone:858-450-4222
Mailing Address - Fax:858-200-3877
Practice Address - Street 1:12340 EL CAMINO REAL STE 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3078
Practice Address - Country:US
Practice Address - Phone:858-450-4222
Practice Address - Fax:858-200-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00345694291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory