Provider Demographics
NPI:1407474190
Name:MY GENIUS LAB LLC
Entity Type:Organization
Organization Name:MY GENIUS LAB LLC
Other - Org Name:GENICS LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARTYOM
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDAPETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-209-2223
Mailing Address - Street 1:5052 S JONES BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0556
Mailing Address - Country:US
Mailing Address - Phone:702-209-2223
Mailing Address - Fax:702-209-3495
Practice Address - Street 1:5052 S JONES BLVD STE 135
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0556
Practice Address - Country:US
Practice Address - Phone:702-209-2223
Practice Address - Fax:702-209-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory