Healthcare Provider Details

I. General information

NPI: 1417355678
Provider Name (Legal Business Name): ATLANTIC DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
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
CULVER CITY CA
90232-2616
US

V. Phone/Fax

Practice location:
  • Phone: 332-208-8824
  • Fax: 332-296-7972
Mailing address:
  • Phone: 332-208-8824
  • Fax: 332-296-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number33D2069816
License Number StateNY

VIII. Authorized Official

Name: NICOLLE SAPO
Title or Position: DIRECTOR
Credential:
Phone: 678-313-1027