Provider Demographics
NPI:1134889470
Name:LAB GENOMICS, LLC
Entity type:Organization
Organization Name:LAB GENOMICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEENA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-438-1009
Mailing Address - Street 1:11160 WARNER AVE STE 415
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4056
Mailing Address - Country:US
Mailing Address - Phone:714-438-1009
Mailing Address - Fax:714-438-2484
Practice Address - Street 1:10299 GRAND RIVER RD STE K
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2204
Practice Address - Country:US
Practice Address - Phone:714-438-1009
Practice Address - Fax:714-438-2484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAB GENOMICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory