Provider Demographics
NPI:1841067964
Name:STAT-GENETIK, INC
Entity type:Organization
Organization Name:STAT-GENETIK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-0767
Mailing Address - Street 1:405 AVE ESMERALDA
Mailing Address - Street 2:PMB 355
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-523-1922
Mailing Address - Fax:787-523-1926
Practice Address - Street 1:RAMIREZ DE ARELLANO AVENUE
Practice Address - Street 2:ESQ MADRID TORRIMAR SHOPPING CENTER LOCAL 5
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-523-1922
Practice Address - Fax:787-523-1926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAT-GENETIK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory