Healthcare Provider Details

I. General information

NPI: 1114936432
Provider Name (Legal Business Name): LLS ACTUAL DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 E WASHINGTON BLVD SUITE A
PASADENA CA
91104-2657
US

IV. Provider business mailing address

1546 E WASHINGTON BLVD SUITE A
PASADENA CA
91104-2657
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-2041
  • Fax: 626-798-2046
Mailing address:
  • Phone: 626-798-2041
  • Fax: 626-798-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. IRINA FREEDMAN
Title or Position: OWNER PRESIDENT
Credential:
Phone: 626-798-2041