Healthcare Provider Details

I. General information

NPI: 1861690620
Provider Name (Legal Business Name): COMMUNITY LABS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W VICTORY BLVD
BURBANK CA
91505-1544
US

IV. Provider business mailing address

3400 W VICTORY BLVD
BURBANK CA
91505-1544
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-3851
  • Fax: 818-843-3653
Mailing address:
  • Phone: 818-843-3851
  • Fax: 818-843-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF11821
License Number StateCA

VIII. Authorized Official

Name: MR. VAHAN ADJIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-631-4025