Provider Demographics
NPI:1841801826
Name:SYMBIOTICA
Entity Type:Organization
Organization Name:SYMBIOTICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-296-5666
Mailing Address - Street 1:1350 BURTON DR STE 210
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3542
Mailing Address - Country:US
Mailing Address - Phone:818-808-9192
Mailing Address - Fax:
Practice Address - Street 1:1350 BURTON DR STE 210
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3542
Practice Address - Country:US
Practice Address - Phone:818-808-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2181231OtherCLIA
CACLF-90000561OtherCA-DOH CLINICAL LABORATORY