Provider Demographics
NPI:1811457922
Name:GENLAB INC
Entity type:Organization
Organization Name:GENLAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PABRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-233-8601
Mailing Address - Street 1:2950 S RAINBOW BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6213
Mailing Address - Country:US
Mailing Address - Phone:702-233-8601
Mailing Address - Fax:702-233-8608
Practice Address - Street 1:1615 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7655
Practice Address - Country:US
Practice Address - Phone:725-777-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory