Provider Demographics
NPI:1316311863
Name:GENETIC TESTING LABORATORY LLC
Entity type:Organization
Organization Name:GENETIC TESTING LABORATORY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINGAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-749-2165
Mailing Address - Street 1:17881 SKY PARK CIR # D-22
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6304
Mailing Address - Country:US
Mailing Address - Phone:949-749-2165
Mailing Address - Fax:
Practice Address - Street 1:17881 SKY PARK CIR # D-22
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6304
Practice Address - Country:US
Practice Address - Phone:949-749-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory