Provider Demographics
NPI:1366111841
Name:DXOME CLIA LABORATORY, INC.
Entity type:Organization
Organization Name:DXOME CLIA LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMONKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-486-1836
Mailing Address - Street 1:8871 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4236
Mailing Address - Country:US
Mailing Address - Phone:949-418-8998
Mailing Address - Fax:949-418-8150
Practice Address - Street 1:8871 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4236
Practice Address - Country:US
Practice Address - Phone:949-409-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory