Provider Demographics
NPI:1427422526
Name:ILLUMINA, INC
Entity type:Organization
Organization Name:ILLUMINA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL LABORATORY
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FACMG
Authorized Official - Phone:858-736-3564
Mailing Address - Street 1:5200 ILLUMINA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4616
Mailing Address - Country:US
Mailing Address - Phone:858-736-3564
Mailing Address - Fax:
Practice Address - Street 1:5200 ILLUMINA WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-4616
Practice Address - Country:US
Practice Address - Phone:858-736-3564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00338066291U00000X
MD1620291U00000X
PA031445291U00000X
RILCO00706291U00000X
FL800026847291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory