Healthcare Provider Details

I. General information

NPI: 1356677744
Provider Name (Legal Business Name): HEALTH NETWORK LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 VANOWEN ST STE 143
N HOLLYWOOD CA
91605-6426
US

IV. Provider business mailing address

10929 VANOWEN ST STE 143
N HOLLYWOOD CA
91605-6426
US

V. Phone/Fax

Practice location:
  • Phone: 818-279-3568
  • Fax:
Mailing address:
  • Phone: 818-279-3568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: VIJAY VAD
Title or Position: CEO
Credential:
Phone: 818-279-3568