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NPI Code Detail

MEDICARE: HEALTHCARE CLINICAL LABORATORY INC.

MEDICARE: HEALTHCARE CLINICAL LABORATORY 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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1427602036
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHCARE CLINICAL LABORATORY INC.
Provider Business Mailing Address
First Line : 5744 SAN FERNANDO RD UNIT 200
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2104
Country : US
Telephone Number : 323-347-5655
Fax Number : 323-347-5654
Provider Business Practice Location Address
First Line : 5744 SAN FERNANDO RD UNIT 200
Second Line :
City : GLENDALE
State : CA
Zip : 91202-2104
Country : US
Telephone Number : 323-347-5655
Fax Number : 323-347-5654
Authorized Official
Title or Position : CEO
Name : SAMER KANSO
Credential :
Telephone Number : 323-347-5655
Provider Enumeration Date : 07/31/2019
Last Update Date : 04/24/2023

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