Provider Demographics
NPI:1073842001
Name:GENLAB INC
Entity Type:Organization
Organization Name:GENLAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PABRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-385-4522
Mailing Address - Street 1:601 S RANCHO DR
Mailing Address - Street 2:SUITE A4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4899
Mailing Address - Country:US
Mailing Address - Phone:702-385-4522
Mailing Address - Fax:702-385-2377
Practice Address - Street 1:601 S RANCHO DR
Practice Address - Street 2:SUITE A4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4899
Practice Address - Country:US
Practice Address - Phone:702-385-4522
Practice Address - Fax:702-385-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20091512600291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory