Healthcare Provider Details

I. General information

NPI: 1356913446
Provider Name (Legal Business Name): QUICKMED DIAGNOSTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 CULVER BLVD
CULVER CITY CA
90232-2616
US

IV. Provider business mailing address

9415 CULVER BLVD PMB#202
CULVER CITY CA
90232-2616
US

V. Phone/Fax

Practice location:
  • Phone: 571-534-3973
  • Fax: 571-592-7556
Mailing address:
  • Phone: 310-905-6441
  • Fax: 213-754-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHYINA PETERSON
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 678-313-1027