MEDICARE: CELL 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1821585381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELL DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	1737 E WASHINGTON BLVD STE 5
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2772
Country	:	US
Telephone Number	:	323-682-2172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 E WASHINGTON BLVD STE 5
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2772
Country	:	US
Telephone Number	:	323-682-2172
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDY MADOYAN
Credential	:
Telephone Number	:	323-682-2172

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/19/2018

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