Organization
GENESIS LABORATORIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBIN DAWN CLARK M.D. (PRESIDENT-OWNER)
(951) 781-9923
Entity
Organization
Contact information
Practice address
5750 DIVISION ST, SUITE 104, RIVERSIDE, CA 92506-3269
(951) 781-9923
(951) 781-9924
Mailing address
5750 DIVISION ST, SUITE 104, RIVERSIDE, CA 92506-3269
(951) 781-9923
(951) 781-9924
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF10367
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAB76729F
—
CA
Enumeration date
05/03/2007
Last updated
05/12/2008
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