Provider Demographics
NPI:1144938747
Name:MY GENIUS LAB LLC
Entity type:Organization
Organization Name:MY GENIUS LAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SETANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-649-8611
Mailing Address - Street 1:2829 BABCOCK RD STE 426
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6012
Mailing Address - Country:US
Mailing Address - Phone:210-503-0003
Mailing Address - Fax:702-209-3495
Practice Address - Street 1:2829 BABCOCK RD STE 426
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6012
Practice Address - Country:US
Practice Address - Phone:210-503-0003
Practice Address - Fax:702-209-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory