Provider Demographics
NPI:1437739299
Name:GENSTAR LABS LLC
Entity Type:Organization
Organization Name:GENSTAR LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-273-1453
Mailing Address - Street 1:407 W IMPERIAL HWY STE H-209
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4832
Mailing Address - Country:US
Mailing Address - Phone:714-273-1453
Mailing Address - Fax:
Practice Address - Street 1:407 W IMPERIAL HWY STE H-209
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4832
Practice Address - Country:US
Practice Address - Phone:714-273-1453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory