Provider Demographics
NPI:1801402383
Name:BRIDGENOMICS, LLC
Entity Type:Organization
Organization Name:BRIDGENOMICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-244-2591
Mailing Address - Street 1:725 LOUDON VIEW LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37737-2301
Mailing Address - Country:US
Mailing Address - Phone:949-244-2591
Mailing Address - Fax:
Practice Address - Street 1:1115 LOS PALOS DR STE A
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3853
Practice Address - Country:US
Practice Address - Phone:805-727-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory ManagementGroup - Single Specialty