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General NPI Number Information
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NPI Number | 1194834028
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Entity Type | Organization
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Legal Business Name | 100 PLAZA CLINICAL LAB INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 100 UCLA MEDICAL PLZ SUITE #245
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City | LOS ANGELES
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State | CA
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Zip | 90024-6970
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Country | US
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Telephone | 310-208-0099
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Fax | 310-208-0963
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Provider Business Mailing Address
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Address Line | 100 UCLA MEDICAL PLZ SUITE #245
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City | LOS ANGELES
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State | CA
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Zip | 90024-6970
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Country | US
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Telephone | 310-208-0099
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Fax | 310-208-0963
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BAHRAM PARSA
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Credential | M.D., PH.D.
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Telephone | 310-208-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF519
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License Number State | CA
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