MEDICARE: 2901 ENTERPRISES, LLC

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	:	1730844986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2901 ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	2272 COLORADO BLVD # 1228
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 N VIGNES ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2927
Country	:	US
Telephone Number	:	213-215-9238
Fax Number	:	213-625-0079

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID AMKRAUT
Credential	:	JD
Telephone Number	:	818-209-4022

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	11/03/2021

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