Healthcare Provider Details

I. General information

NPI: 1851913354
Provider Name (Legal Business Name): THE LAAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664B W BROADWAY
GLENDALE CA
91204-1008
US

IV. Provider business mailing address

664B W BROADWAY
GLENDALE CA
91204-1008
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-5222
  • Fax: 818-484-4401
Mailing address:
  • Phone: 818-843-5222
  • Fax: 818-484-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: MS. SOPHIA MORADI
Title or Position: MANAGING MEMBER
Credential:
Phone: 818-400-8300