Provider Demographics
NPI:1588712020
Name:GENETIC DISEASE SCREENING PROGRAM, STATE OF CA
Entity type:Organization
Organization Name:GENETIC DISEASE SCREENING PROGRAM, STATE OF CA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF LABORATORY SERVICES BRANCH
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FACMG
Authorized Official - Phone:510-231-1704
Mailing Address - Street 1:850 MARINA BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-6403
Mailing Address - Country:US
Mailing Address - Phone:866-718-7915
Mailing Address - Fax:510-412-1558
Practice Address - Street 1:850 MARINA BAY PKWY # G-272
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-6403
Practice Address - Country:US
Practice Address - Phone:510-412-1502
Practice Address - Fax:510-412-1558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0862216291U00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D0862216OtherCLIA