Organization
GENETICA DIAGNOSTIC LABORATORY, LLC
Active
Other names
BAS Premier Lab
Organization subpart
No
Provider details
NPI number
Authorized official
ALEJANDRO CONTRERAS MD (MEDICAL DIRECTOR)
(832) 672-6984
Entity
Organization
Contact information
Practice address
11720 W AIRPORT BLVD STE 800, MEADOWS PLACE, TX 77477-3062
(832) 672-6984
Mailing address
22751 PROFESSIONAL DR STE 210, KINGWOOD, TX 77339-6021
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2074140
CLIA
TX
Enumeration date
08/27/2018
Last updated
08/27/2018
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