Provider Demographics
NPI:1063906691
Name:PERSONCOGENE LLC
Entity type:Organization
Organization Name:PERSONCOGENE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENETIC COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIE
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:KLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCGC
Authorized Official - Phone:650-796-7556
Mailing Address - Street 1:422 PISMO CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-5245
Mailing Address - Country:US
Mailing Address - Phone:650-796-7556
Mailing Address - Fax:
Practice Address - Street 1:2950 BUSKIRK AVE STE 300
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-6900
Practice Address - Country:US
Practice Address - Phone:925-266-5777
Practice Address - Fax:925-300-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Single Specialty