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
State | License ID | Taxonomies |
---|---|---|
CA | 00345784 | 291U00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |