Provider Demographics
NPI:1063541019
Name:GENETIC DIAGNOSTIC GROUP
Entity type:Organization
Organization Name:GENETIC DIAGNOSTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO CORNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-728-8316
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0087
Mailing Address - Country:US
Mailing Address - Phone:787-728-8316
Mailing Address - Fax:787-728-8316
Practice Address - Street 1:252 SAN JORGE STREET
Practice Address - Street 2:SAN JORGE MEDICAL BUILDING SUITE 408
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-0000
Practice Address - Country:US
Practice Address - Phone:787-728-8316
Practice Address - Fax:787-728-8316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty