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General NPI Number Information
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NPI Number | 1881033587
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Entity Type | Organization
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Legal Business Name | IMMUNOSCIENCES LAB., INC.
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 822 S ROBERTSON BLVD STE 312
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City | LOS ANGELES
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State | CA
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Zip | 90035-1613
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Country | US
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Telephone | 310-657-1077
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Fax | 310-657-1053
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Provider Business Mailing Address
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Address Line | 822 S ROBERTSON BLVD SUITE 312
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City | LOS ANGELES
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State | CA
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Zip | 90035-1613
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Country | US
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Telephone | 310-657-1077
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Fax | 310-657-1053
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Authorized Official
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Title or Position | CEO/TECHNICAL DIRECTOR
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Name | DR. ARISTO VOJDANI
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Credential | PH.D, M.SC., C.L.S.
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Telephone | 310-657-1077
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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 | CLF 00000085
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License Number State | CA
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