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NPI Code Detail

MEDICARE: LLS ACTUAL DIAGNOSTICS INC

MEDICARE: LLS ACTUAL DIAGNOSTICS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1293D00000XPhysiological Laboratory

General Provider Information

NPI Number : 1114936432
Entity Type Code : Organization
Provider Name (Legal Business Name) : LLS ACTUAL DIAGNOSTICS INC
Provider Business Mailing Address
First Line : 1546 E WASHINGTON BLVD
Second Line : SUITE A
City : PASADENA
State : CA
Zip : 91104-2657
Country : US
Telephone Number : 626-798-2041
Fax Number : 626-798-2046
Provider Business Practice Location Address
First Line : 1546 E WASHINGTON BLVD
Second Line : SUITE A
City : PASADENA
State : CA
Zip : 91104-2657
Country : US
Telephone Number : 626-798-2041
Fax Number : 626-798-2046
Authorized Official
Title or Position : OWNER PRESIDENT
Name : MRS. IRINA FREEDMAN
Credential :
Telephone Number : 626-798-2041
Provider Enumeration Date : 08/05/2006
Last Update Date : 08/22/2020

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Directions to “LLS ACTUAL DIAGNOSTICS INC ” Practice Location

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