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Provider Information for 1245812288

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MYGENOMEMYLIFEMGML

Organization Subpart: NO

Organization NPI: 1245812288

Calendar   Last Updated:  2021-08-10
  Certification Date:  2021-08-10

Details

Name Value
NPI 1245812288
Enumeration Date 2021-04-28
NPI Type 2- Organization
Status Active
Authorized Official Information Name: DEEPTI GUPTA
Title: ADMINISTRATOR
Phone: 513-666-2440
Mailing Address 1629 K ST NW STE 300NW
WASHINGTON, DC 20006-1602
United States

Phone: 202-476-0727 | Fax:
View Map External Link
Primary Practice Address 1629 K ST NW STE 300NW
WASHINGTON, DC 20006-1602
United States

Phone: 202-476-0727 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193400000X MULTIPLE SINGLE SPECIALTY GROUP
247000000X - Technician, Health Information
No 261QH0100X - Clinic/Center Health Services