AMBRY GENETICS CORPORATION

Provider Demographics

• NPI: 1861568784
• Name: AMBRY GENETICS CORPORATION
• Entity type: Organization
• Organization Name: AMBRY GENETICS CORPORATION
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: MICHAEL
• Authorized Official - Middle Name: RAYMOND
• Authorized Official - Last Name: MARTINSON
• Authorized Official - Phone: 949-900-5585
• Mailing Address - Street 1: 1 ENTERPRISE
• Mailing Address - City: ALISO VIEJO
• Mailing Address - State: CA
• Mailing Address - Zip Code: 92656-2606
• Mailing Address - Country: US
• Mailing Address - Phone: 949-457-4143
• Mailing Address - Fax: 949-900-5501
• Practice Address - Street 1: 7 ARGONAUT
• Practice Address - City: ALISO VIEJO
• Practice Address - State: CA
• Practice Address - Zip Code: 92656-1423
• Practice Address - Country: US
• Practice Address - Phone: 949-900-5500
• Practice Address - Fax: 949-900-5501
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-24
• Last Update Date: 2024-08-22

Provider Licenses

State	License ID	Taxonomies
CA	CLF11694	291U00000X
CA		291U00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	291U00000X	Laboratories	Clinical Medical Laboratory

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MT	0421379	Medicaid
PA	1024063580001	Medicaid
WA	1061577	Medicaid
MD	419149800	Medicaid
MN	462462900	Medicaid
KY	7100029600	Medicaid
SC	L00282	Medicaid
TN	1517245	Medicaid
ND	15197	Medicaid
OK	200034590A	Medicaid
MI	453277016	Medicaid
CA	7154701	Other	LAP CAP
ID	806650800	Medicaid
NJ	0054976	Medicaid
VA	010127904	Medicaid
NE	10025004600	Medicaid
AK	1006834	Medicaid
IN	200967250A	Medicaid
TX	212446302	Medicaid
CO	69584834	Medicaid
AZ	797178	Medicaid
AR	157113709	Medicaid
GA	003151337A	Medicaid
VT	1017246	Medicaid
NY	2958381	Medicaid
NM	86759825	Medicaid
WV	9880101-000	Medicaid
LA	1464660	Medicaid
TX	212446301	Medicaid
AL	690000008	Medicaid
CA	LAB81414F	Medicaid
KS	200267720A	Medicaid
OH	2418146	Medicaid
MS	775960	Medicaid
MD	419149800	Medicaid