Provider Demographics
NPI:1043797541
Name:US GENETICS LAB, LLC
Entity Type:Organization
Organization Name:US GENETICS LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CHILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-858-1082
Mailing Address - Street 1:15821 VENTURA BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4793
Mailing Address - Country:US
Mailing Address - Phone:818-858-1082
Mailing Address - Fax:323-729-3933
Practice Address - Street 1:2769 SUNRIDGE HEIGHTS PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5048
Practice Address - Country:US
Practice Address - Phone:702-701-8239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular GeneticsGroup - Single Specialty