# GENETIC DIAGNOSTIC GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063541019
- **Authorized official:** DR. ALBERTO SANTIAGO CORNIER M.D. (PRESIDENT)
- **Authorized official phone:** (787) 728-8316

## Contact information

- **Practice address:** 252 SAN JORGE STREET, SAN JORGE MEDICAL BUILDING SUITE 408, SANTURCE, PR 00912-0000
- **Practice address phone:** (787) 728-8316
- **Practice address fax:** (787) 728-8316
- **Mailing address:** PO BOX 87, MAYAGUEZ, PR 00681-0087
- **Mailing address phone:** (787) 728-8316
- **Mailing address fax:** (787) 728-8316

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | NULL | Yes |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 08/22/2020