MEDICARE: EARLYDIAGNOSTICS, 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

General Provider Information

NPI Number	:	1245193523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLYDIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	30601 AGOURA RD STE 250
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2149
Country	:	US
Telephone Number	:	951-640-2357
Fax Number	:

Provider Business Practice Location Address
First Line	:	30601 AGOURA RD STE 250
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2149
Country	:	US
Telephone Number	:	951-640-2357
Fax Number	:

Authorized Official
Title or Position	:	VP LABORATORY OPERATIONS
Name	:	MRS. LARA BADEN
Credential	:
Telephone Number	:	951-640-2357

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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