Glycominds, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GLYCOMINDS, INC.

Practice address

4685 Runway St
Suite J
Simi Valley, CA 93063-3470

Phone

(805) 791-2094

NPI assigned

Jun 23, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Avinoam A Dukler, PH.D.

Title

Officer

Phone

(805) 791-2094

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1841501921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 RUNWAY ST STE J",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930633470",
            "telephone_number": "805-791-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4685 RUNWAY ST",
            "address_2": "SUITE J",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930633470",
            "telephone_number": "805-791-2094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLYCOMINDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-23",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "DUKLER",
        "authorized_official_first_name": "AVINOAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "805-791-2094",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Simi Valley, CA
• Providers in Simi Valley, 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 May 17, 2011; 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.