Provider Demographics
NPI:1245494517
Name:EXAGEN INC.
Entity type:Organization
Organization Name:EXAGEN INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-539-3031
Mailing Address - Street 1:PO BOX 27561
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7561
Mailing Address - Country:US
Mailing Address - Phone:888-452-1522
Mailing Address - Fax:760-479-6486
Practice Address - Street 1:1261 LIBERTY WAY STE C
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8356
Practice Address - Country:US
Practice Address - Phone:888-452-1522
Practice Address - Fax:760-479-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 00334804291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8369OtherNEW YORK STATE DEPARTMENT OF HEALTH
ZZZ555113YOtherBLUE SHIELD OF CALIFORNIA
MD1484OtherMARYLAND DEPT OF HEALTH
RILCO00685OtherRHODE ISLAND DEPT OF HEALTH
PA31066OtherPENNSYLVANIA DEPT OF HEALTH
05D1075048OtherCLIA
CACDF-00334804OtherCLINICAL AND PUBLIC HEALTH LABORATORY LICENSE