Provider Demographics
NPI:1982603981
Name:LABORATORIO GENESIS DEL DORADO
Entity Type:Organization
Organization Name:LABORATORIO GENESIS DEL DORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:ARRIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-796-2282
Mailing Address - Street 1:PO BOX 10045
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0045
Mailing Address - Country:US
Mailing Address - Phone:787-796-2282
Mailing Address - Fax:787-796-6611
Practice Address - Street 1:CALLE MARGINAL COSTA DE ORO CARR 693
Practice Address - Street 2:LOCAL A6
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-0000
Practice Address - Country:US
Practice Address - Phone:787-796-2282
Practice Address - Fax:787-796-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR993291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31375Medicare ID - Type UnspecifiedPROVEEDOR