Basic Information
| Provider Information | |||||||||
| NPI: | 1134306541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESOTERIX GENETIC COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2270 | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272162240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002227566 | ||||||||
| FaxNumber: | 3364361048 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 EAST HUNTINGTON DR | ||||||||
| Address2: | |||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910163636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264717443 | ||||||||
| FaxNumber: | 3104825204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8002227566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QG0250X | Y | Ambulatory Health Care Facilities | Clinic/Center | Genetics |
No ID Information.