Provider Demographics
NPI:1841015575
Name:GENOMAI LLC
Entity type:Organization
Organization Name:GENOMAI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:NOEMI
Authorized Official - Last Name:PEREZ PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-709-5519
Mailing Address - Street 1:104 GERBERA STREET
Mailing Address - Street 2:(OPTIONAL)
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4790
Mailing Address - Country:US
Mailing Address - Phone:503-709-5519
Mailing Address - Fax:
Practice Address - Street 1:104 GERBERA STREET
Practice Address - Street 2:(OPTIONAL)
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4790
Practice Address - Country:US
Practice Address - Phone:503-709-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular GeneticsGroup - Multi-Specialty