Provider Demographics
NPI:1760840342
Name:INTRINSIC LIFE SCIENCES
Entity Type:Organization
Organization Name:INTRINSIC LIFE SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-459-1758
Mailing Address - Street 1:505 COAST BOULEVARD SOUTH
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LAJOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:877-457-5888
Mailing Address - Fax:848-459-3794
Practice Address - Street 1:505 COAST BOULEVARD SOUTH
Practice Address - Street 2:SUITE 408
Practice Address - City:LAJOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:877-457-5888
Practice Address - Fax:848-459-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00345784291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory