Provider Demographics
NPI:1891152534
Name:GENSI
Entity Type:Organization
Organization Name:GENSI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-270-1594
Mailing Address - Street 1:11125 FLINTKOTE AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1213
Mailing Address - Country:US
Mailing Address - Phone:858-270-1594
Mailing Address - Fax:858-408-7545
Practice Address - Street 1:11125 FLINTKOTE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1213
Practice Address - Country:US
Practice Address - Phone:858-270-1594
Practice Address - Fax:858-408-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2102775291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory