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General NPI Number Information
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NPI Number | 1487600565
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Entity Type | Organization
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Legal Business Name | ALLSTATE INVESTMENT REALTY INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 10133 RIVERSIDE DR
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2533
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Country | US
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Telephone | 818-752-6030
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Fax | 818-752-6033
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Provider Business Mailing Address
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Address Line | 10133 RIVERSIDE DR
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2533
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Country | US
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Telephone | 818-752-6030
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Fax | 818-752-6033
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MIKE AVEDISSIAN
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Credential |
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Telephone | 818-752-6030
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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 | CLF10750
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License Number State | CA
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