MEDICARE: ALLSTATE INVESTMENT REALTY 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	CLF10750	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487600565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLSTATE INVESTMENT REALTY INC

Provider Business Mailing Address
First Line	:	10133 RIVERSIDE DR
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2533
Country	:	US
Telephone Number	:	818-752-6030
Fax Number	:	818-752-6033

Provider Business Practice Location Address
First Line	:	10133 RIVERSIDE DR
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-2533
Country	:	US
Telephone Number	:	818-752-6030
Fax Number	:	818-752-6033

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MIKE AVEDISSIAN
Credential	:
Telephone Number	:	818-752-6030

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	01/11/2013

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