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General NPI Number Information
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NPI Number | 1285936765
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Entity Type | Organization
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Legal Business Name | EXPRESS RELIABLE DIAGNOSTIC INC
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 19634 VENTURA BLVD STE 315
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City | TARZANA
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State | CA
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Zip | 91356-2995
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Country | US
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Telephone | 818-293-8049
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Fax | 818-708-2167
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Provider Business Mailing Address
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Address Line | 19634 VENTURA BLVD STE 315
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City | TARZANA
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State | CA
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Zip | 91356-2995
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Country | US
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Telephone | 818-293-8049
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Fax | 818-708-2167
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Authorized Official
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Title or Position | PRESIDENT
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Name | NIKITA GOLDRING
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Credential |
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Telephone | 818-293-8049
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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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