Provider Demographics
NPI:1902865868
Name:MONOGRAM BIOSCIENCES, INC
Entity Type:Organization
Organization Name:MONOGRAM BIOSCIENCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-222-7566
Mailing Address - Street 1:345 OYSTER POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1913
Mailing Address - Country:US
Mailing Address - Phone:650-635-1100
Mailing Address - Fax:888-369-0023
Practice Address - Street 1:345 OYSTER POINT BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-1913
Practice Address - Country:US
Practice Address - Phone:650-635-1100
Practice Address - Fax:888-369-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11444291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB41934FMedicaid
FL030676200Medicaid
DC4424050Medicaid
NY02084866Medicaid
NJ8404909Medicaid
DC4424050Medicaid