MEDICARE: HEALTHY LIFE DIAGNOSTICS, 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	293D00000X	Physiological Laboratory		CA

General Provider Information

NPI Number	:	1770633851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIFE DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	1930 WILSHIRE BLVD STE 1209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3622
Country	:	US
Telephone Number	:	213-413-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 WILSHIRE BLVD STE 1209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3622
Country	:	US
Telephone Number	:	213-413-2010
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GENNADIY BIRGER
Credential	:
Telephone Number	:	323-528-0606

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	10/03/2008

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