Healthcare Provider Details

I. General information

NPI: 1417099383
Provider Name (Legal Business Name): V.E.D.C LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST STE 225
BURBANK CA
91505-4571
US

IV. Provider business mailing address

201 S. BUENA VISTA #225
BURBANK CA
91505
US

V. Phone/Fax

Practice location:
  • Phone: 818-239-0288
  • Fax: 818-239-0289
Mailing address:
  • Phone: 818-239-0288
  • Fax: 818-239-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF333296
License Number StateCA

VIII. Authorized Official

Name: DR. MINH Q MACH
Title or Position: LAB DIRECTOR
Credential: M.D.
Phone: 818-239-0288