MEDICARE: MEDEX LABORATORIES SERVICES 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
1	291U00000X	Clinical Medical Laboratory	CLF333109	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D1055209	OTHER	CA	CLIA

General Provider Information

NPI Number	:	1134442858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEX LABORATORIES SERVICES INC

Provider Business Mailing Address
First Line	:	5242 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-2439
Country	:	US
Telephone Number	:	818-265-0001
Fax Number	:	818-265-0008

Provider Business Practice Location Address
First Line	:	5242 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-2439
Country	:	US
Telephone Number	:	818-265-0001
Fax Number	:	818-265-0008

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROUBEN BARSEGIAN
Credential	:
Telephone Number	:	818-265-0001

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	06/20/2018

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