Provider Demographics
NPI:1760222004
Name:CONCIERGE DIAGNOSTICS
Entity type:Organization
Organization Name:CONCIERGE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARAMO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-333-6817
Mailing Address - Street 1:10601 WALKER ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10601 WALKER ST FL 1
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4733
Practice Address - Country:US
Practice Address - Phone:213-440-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty