Provider Demographics
NPI:1730357658
Name:PROPRIUS, INC.
Entity type:Organization
Organization Name:PROPRIUS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-436-1803
Mailing Address - Street 1:12264 EL CAMINO REAL STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-0001
Mailing Address - Country:US
Mailing Address - Phone:858-436-1816
Mailing Address - Fax:858-259-8941
Practice Address - Street 1:12264 EL CAMINO REAL STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-0001
Practice Address - Country:US
Practice Address - Phone:858-436-1816
Practice Address - Fax:858-259-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory