MEDICARE: ACCESS 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	05D1092532	CA

General Provider Information

NPI Number	:	1902048218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS LABORATORIES, INC

Provider Business Mailing Address
First Line	:	703 IVY STREET
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204
Country	:	US
Telephone Number	:	818-484-8834
Fax Number	:	818-484-8836

Provider Business Practice Location Address
First Line	:	703 IVY ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1003
Country	:	US
Telephone Number	:	818-484-8834
Fax Number	:	818-484-8836

Authorized Official
Title or Position	:	CFO
Name	:	JACOB POGOSYAN
Credential	:
Telephone Number	:	818-484-8834

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/06/2009

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