MEDICARE: VALLEY VIEW CLINICAL LAB 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		AZ

General Provider Information

NPI Number	:	1609951615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VIEW CLINICAL LAB INC

Provider Business Mailing Address
First Line	:	4514 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5304
Country	:	US
Telephone Number	:	602-297-0828
Fax Number	:	602-297-0829

Provider Business Practice Location Address
First Line	:	4514 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5304
Country	:	US
Telephone Number	:	602-297-0828
Fax Number	:	602-297-0829

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMUEL ABADJIAN
Credential	:
Telephone Number	:	602-297-0828

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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