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General NPI Number Information
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NPI Number | 1912129222
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Entity Type | Organization
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Legal Business Name | GENESIS LABORATORIES, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 5750 DIVISION ST SUITE 104
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City | RIVERSIDE
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State | CA
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Zip | 92506-3269
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Country | US
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Telephone | 951-781-9923
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Fax | 951-781-9924
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Provider Business Mailing Address
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Address Line | 5750 DIVISION ST SUITE 104
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City | RIVERSIDE
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State | CA
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Zip | 92506-3269
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Country | US
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Telephone | 951-781-9923
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Fax | 951-781-9924
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | DR. ROBIN DAWN CLARK
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Credential | M.D.
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Telephone | 951-781-9923
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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 | CLF10367
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License Number State | CA
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