MEDICARE: MATRIGENE LABORATORIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1255288098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIGENE LABORATORIES INC

Provider Business Mailing Address
First Line	:	6618 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1703
Country	:	US
Telephone Number	:	818-658-2122
Fax Number	:	818-403-3386

Provider Business Practice Location Address
First Line	:	6618 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1703
Country	:	US
Telephone Number	:	818-658-2122
Fax Number	:	818-403-3386

Authorized Official
Title or Position	:	CEO
Name	:	ANASTASIIA GASPRIAN
Credential	:
Telephone Number	:	818-658-2122

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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