MEDICARE: AMBULA DIAGNOSTICS LLC

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

General Provider Information

NPI Number	:	1215724968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULA DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	13912 VENTURA BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-3510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 SHERMAN OAKS AVE STE 101
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3826
Country	:	US
Telephone Number	:	323-910-2461
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KHALIL JAMMAL
Credential	:
Telephone Number	:	323-910-2461

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	06/23/2025

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