Esoterix Genetic Laboratories LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ESOTERIX GENETIC LABORATORIES LLC

Practice address

43 Marisol
Newport Coast, CA 92657-1212

Phone

(626) 543-0334

NPI assigned

Sep 17, 2014

Organization subpart

No

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

Authorized official

Name

Kimberly Williams

Title

Vice President

Phone

(800) 222-7566

Specialties & licenses 1

Addresses

Other identifiers 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Laboratory Corporation of America Holdings

  • Clinical Medical Laboratory
  • Cromwell, CT
  • NPI 1700517984

  Member Of

  NPD member

Networks

• HealthSun Health Plans Network

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1982006318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2240",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272162240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 MARISOL",
            "city": "NEWPORT COAST",
            "state": "CA",
            "postal_code": "926571212",
            "telephone_number": "626-543-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESOTERIX GENETIC LABORATORIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-17",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "800-222-7566"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2047225",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward George Deeb Jr., D.D.S.
• DFW Physicians Ipa, PLLC
• Andrew Tri-Anh Gia Dinh, DMD
• Annie Le Doi, PHARM.D
• Nermine Eid
• Cathy Krantz Evangelatos, PSY.D.
• Farnaz Fadavi, DMD
• Sheena Nicole Farokhian, NMD
• Richard Herbert Fixler, M.D.
• Leora Fogel, PHARM.D.

• Clinical Medical Laboratory in Newport Coast, CA
• Providers in Newport Coast, 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 Mar 28, 2022; 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.