Healthcare Provider Details

I. General information

NPI: 1588895593
Provider Name (Legal Business Name): SCIONA LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 VAN NUYS BLVD STE 379
VAN NUYS CA
91401-4602
US

IV. Provider business mailing address

5632 VAN NUYS BLVD STE 379
VAN NUYS CA
91401-4602
US

V. Phone/Fax

Practice location:
  • Phone: 818-271-9213
  • Fax:
Mailing address:
  • Phone: 818-271-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GEORGE JABAJI
Title or Position: PRESIDENT
Credential:
Phone: 818-271-9213