Provider Demographics
NPI:1972829752
Name:CYNOGEN, INC.
Entity Type:Organization
Organization Name:CYNOGEN, INC.
Other - Org Name:PERSONALIZEDX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:HALLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-587-7516
Mailing Address - Street 1:25901 COMMERCENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8805
Mailing Address - Country:US
Mailing Address - Phone:877-429-6643
Mailing Address - Fax:949-587-7502
Practice Address - Street 1:25901 COMMERCENTRE DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8805
Practice Address - Country:US
Practice Address - Phone:877-429-6643
Practice Address - Fax:949-587-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
CACLF00339441291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory