Provider Demographics
NPI:1639703168
Name:GENOLAB INC
Entity Type:Organization
Organization Name:GENOLAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGLIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-522-3077
Mailing Address - Street 1:5300 SANTA MONICA BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1259
Mailing Address - Country:US
Mailing Address - Phone:323-522-3077
Mailing Address - Fax:888-765-4732
Practice Address - Street 1:5300 SANTA MONICA BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1259
Practice Address - Country:US
Practice Address - Phone:323-522-3077
Practice Address - Fax:888-765-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory