MEDICARE: LABORATORIO GENESIS DEL DORADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	993	PR

General Provider Information

NPI Number	:	1982603981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO GENESIS DEL DORADO

Provider Business Mailing Address
First Line	:	PO BOX 10045
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-0045
Country	:	US
Telephone Number	:	787-796-2282
Fax Number	:	787-796-6611

Provider Business Practice Location Address
First Line	:	CALLE MARGINAL COSTA DE ORO CARR 693
Second Line	:	LOCAL A6
City	:	DORADO
State	:	PR
Zip	:	00646-0000
Country	:	US
Telephone Number	:	787-796-2282
Fax Number	:	787-796-6611

Authorized Official
Title or Position	:	PRESIDENTA
Name	:	MS. CARMEN LYDIA ARRIETA
Credential	:
Telephone Number	:	787-796-2282

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/22/2020

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