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General NPI Number Information
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NPI Number | 1407861990
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Entity Type | Organization
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Legal Business Name | 21ST CENTURY DIAGNOSTIC LABORATORY, INC.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 121 N VICTORY BLVD
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City | BURBANK
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State | CA
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Zip | 91502-1837
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Country | US
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Telephone | 323-660-9480
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N VICTORY BLVD
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City | BURBANK
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State | CA
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Zip | 91502-1837
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Country | US
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Telephone | 323-660-9480
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Fax |
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Authorized Official
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Title or Position | SERCRETARY
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Name | HASMIK MELKUMYAN
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Credential | CLS
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Telephone | 323-660-9480
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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 | 05D0956168
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License Number State | CA
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