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General NPI Number Information
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NPI Number | 1245697655
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Entity Type | Organization
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Legal Business Name | 21053 DEVNSHIRE 106
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Dates
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Enumeration Date | 01/15/2016
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 21053 DEVONSHIRE ST STE 106
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City | CHATSWORTH
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State | CA
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Zip | 91311-8247
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Country | US
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Telephone | 818-274-1843
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Fax | 818-789-1061
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Provider Business Mailing Address
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Address Line | 21053 DEVONSHIRE ST STE 106
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City | CHATSWORTH
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State | CA
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Zip | 91311-8247
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Country | US
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Telephone | 818-274-1843
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Fax | 818-789-1061
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Authorized Official
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Title or Position | DIRECTOR OF RESEARCH
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Name | MRS. YADIRA VALLES
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Credential | M.D., PH.D.
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Telephone | 818-274-1843
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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 | CLF 00328498
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License Number State | CA
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