Provider Demographics
NPI:1790265163
Name:GENBEN LIFESCIENCES CORPORATION
Entity Type:Organization
Organization Name:GENBEN LIFESCIENCES CORPORATION
Other - Org Name:GB HEALTHWATCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-224-9879
Mailing Address - Street 1:6370 LUSK BLVD STE F205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2755
Mailing Address - Country:US
Mailing Address - Phone:858-224-9879
Mailing Address - Fax:
Practice Address - Street 1:6370 LUSK BLVD STE F205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-224-9879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251K00000XAgenciesPublic Health or Welfare
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty