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General NPI Number Information
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NPI Number | 1215400650
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Entity Type | Organization
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Legal Business Name | DYNAMIC HEALTH LABS
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 516 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-1306
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Country | US
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Telephone | 323-920-0448
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Fax | 323-380-7991
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Provider Business Mailing Address
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Address Line | 516 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-1306
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Country | US
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Telephone | 323-920-0448
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Fax | 323-380-7991
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Authorized Official
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Title or Position | CFO
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Name | MR. SHAWN EBRAHIMIAN
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Credential |
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Telephone | 213-595-1000
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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 |
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License Number State |
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