Provider Demographics
NPI:1689607384
Name:CARE DX, INC.
Entity Type:Organization
Organization Name:CARE DX, INC.
Other - Org Name:XDX, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-287-2322
Mailing Address - Street 1:3260 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005
Mailing Address - Country:US
Mailing Address - Phone:415-287-2300
Mailing Address - Fax:415-287-2456
Practice Address - Street 1:3260 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005
Practice Address - Country:US
Practice Address - Phone:415-287-2300
Practice Address - Fax:415-287-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332008291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32620ZMedicare PIN