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General NPI Number Information
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NPI Number | 1285160887
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Entity Type | Organization
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Legal Business Name | GENLAB CORPORATION
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 1417 SE 1ST AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1805
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Country | US
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Telephone | 954-530-8332
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Fax | 954-533-7605
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Provider Business Mailing Address
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Address Line | 1417 SE 1ST AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1805
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Country | US
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Telephone | 954-530-8332
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Fax | 954-533-7605
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Authorized Official
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Title or Position | CFO
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Name | MR. ALEJANDRO PABRIAGA
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Credential |
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Telephone | 725-777-8066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 14D1082277
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License Number State | IL
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