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General NPI Number Information
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NPI Number | 1427284934
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Entity Type | Organization
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Legal Business Name | CR DYGERT & CO
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 1335 N LA BREA AVE STE 2109
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City | LOS ANGELES
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State | CA
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Zip | 90028-7526
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Country | US
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Telephone | 323-448-8410
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Fax |
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Provider Business Mailing Address
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Address Line | 19528 VENTURA BLVD SUITE 649
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City | TARZANA
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State | CA
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Zip | 91356-2917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHARLES DYGERT
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Credential |
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Telephone | 323-448-8410
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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 | 05D1085761
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License Number State | CA
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