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General NPI Number Information
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NPI Number | 1629218755
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Entity Type | Organization
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Legal Business Name | CANDU LAB SERVICES INC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 15904 STRATHERN ST SUITE 19
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City | VAN NUYS
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State | CA
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Zip | 91406-1314
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Country | US
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Telephone | 818-300-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 15904 STRATHERN ST SUITE 19
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City | VAN NUYS
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State | CA
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Zip | 91406-1314
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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 | BETTY S JELEN
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Credential |
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Telephone | 818-300-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A35493
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License Number State | CA
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