Provider Demographics
NPI:1649225632
Name:GENETICS CENTER
Entity Type:Organization
Organization Name:GENETICS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TOURAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-288-3500
Mailing Address - Street 1:211 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-288-3500
Mailing Address - Fax:714-288-3510
Practice Address - Street 1:211 SOUTH MAIN STREET
Practice Address - Street 2:SUITE E
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-288-3500
Practice Address - Fax:714-288-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB79108FMedicaid
CALAB79108FMedicaid