Genex Laboratory Professional Corporation

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF 00345153 Issued in CA

Legal business name

GENEX LABORATORY PROFESSIONAL CORPORATION

Doing business as

Genex Laboratory Professional Corporation

Practice address

3151 Airway Ave Ste M1
Costa Mesa, CA 92626-4626

Phone

(949) 610-7253

Fax

(949) 610-7253

NPI assigned

Nov 15, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Damien Johann Burgess, DC, APRN, NP-CNPI 1699917138

Title

Ceo

Phone

(949) 610-7253

Specialties & licenses 1

Addresses

Other names 1

• Genex Laboratory Professional Corporation Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Damien Johann Burgess, D.C., APRN, NP-C

  • Nurse Practitioner
  • Newport Beach, CA
  • NPI 1699917138

  Multi-Specialty

  NPD Authorized official
• John M Molina, DO

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1770547523
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1801226543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE STE M1",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264626",
            "telephone_number": "949-610-7253",
            "fax_number": "949-610-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE STE M1",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264626",
            "telephone_number": "949-610-7253",
            "fax_number": "949-610-7253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENEX LABORATORY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "DAMIEN",
        "authorized_official_middle_name": "JOHANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-610-7253",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, APRN, NP-C"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF 00345153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genex Laboratory Professional Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Bernice Gauss, IBCLC
• Beatrize Gaytan
• Elizabeth Beltran Gaytan
• Genesishealthcarenetwork,Inc. (SerenityShoresRecoveryCenter)
• Genetic Institute of Anti Aging
• Gentle Breeze Manor LLC
• Gentle Hands Health Care Service, LLC
• Kalani Ann George
• Brian Kenneth Gerbode, D.C.
• Shawnie Gerstenberg

• Clinical Medical Laboratory in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.