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General NPI Number Information
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NPI Number | 1811492028
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Entity Type | Individual
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Provider Name | ANDY MADOYAN
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Gender | Male
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 1737 E WASHINGTON BLVD STE 5
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City | PASADENA
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State | CA
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Zip | 91104-2772
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Country | US
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Telephone | 626-314-2222
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Fax | 626-314-2224
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Provider Business Mailing Address
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Address Line | 1737 E WASHINGTON BLVD STE 5
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City | PASADENA
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State | CA
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Zip | 91104-2772
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Country | US
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Telephone | 626-314-2222
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Fax | 626-314-2224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | 05D2145028
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License Number State | CA
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