Provider Demographics
NPI:1104899376
Name:DIAGNOSTIC CYTOGENETICS
Entity type:Organization
Organization Name:DIAGNOSTIC CYTOGENETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REGULATORY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KYNDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-618-9107
Mailing Address - Street 1:2360 W COMMODORE WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1285
Mailing Address - Country:US
Mailing Address - Phone:206-328-2026
Mailing Address - Fax:206-325-2975
Practice Address - Street 1:2360 W COMMODORE WAY STE 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1285
Practice Address - Country:US
Practice Address - Phone:206-328-2026
Practice Address - Fax:206-325-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTS-0439291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7271406Medicaid