MEDICARE: DISCOVERY MEDICAL LABORATORY

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	05D1081778	CA

General Provider Information

NPI Number	:	1699942565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVERY MEDICAL LABORATORY

Provider Business Mailing Address
First Line	:	3404 GLENDALE BLVD # B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1815
Country	:	US
Telephone Number	:	323-666-2526
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 GLENDALE BLVD # B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1815
Country	:	US
Telephone Number	:	323-666-2526
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. KLARIS NAZARYAN
Credential	:
Telephone Number	:	323-666-2526

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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