Source Bioscience Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOURCE BIOSCIENCE INC

Practice address

6696 Mesa Ridge Rd Ste B
San Diego, CA 92121-2950

Phone

(858) 344-7993

NPI assigned

Oct 16, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Yu, MS, MBA, MLS (ASCP)

Title

Lab Consultant

Phone

(626) 236-2706

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634342400000",
    "number": "1669135661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6696 MESA RIDGE RD STE B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212950",
            "telephone_number": "858-344-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6696 MESA RIDGE RD STE B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212950",
            "telephone_number": "858-344-7993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE BIOSCIENCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-16",
        "last_updated": "2021-10-16",
        "certification_date": "2021-10-16",
        "status": "A",
        "authorized_official_last_name": "YU",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "LAB CONSULTANT",
        "authorized_official_telephone_number": "626-236-2706",
        "authorized_official_credential": "MS, MBA, MLS (ASCP)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andre Soumekh
• M Hertzel Soumekh, M.D.
• Sound Imaging, Inc.
• Vanna Soung
• Source Acupuncture Corp
• Source Empowered Wellness
• Celesta Carla Sousa, BS
• John-Anthony Sousa
• South America Medical Network Inc
• South Bay Comprehensive Primary Care a Medical Corp

• Clinical Medical Laboratory in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.