MEDICARE: MATRIX LABORATORIES 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D2288078	OTHER	CA	CMS - CLIA

General Provider Information

NPI Number	:	1871372862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX LABORATORIES INC

Provider Business Mailing Address
First Line	:	6618 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1703
Country	:	US
Telephone Number	:	747-755-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	6618 SAN FERNANDO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1703
Country	:	US
Telephone Number	:	747-755-2005
Fax Number	:	747-441-2005

Authorized Official
Title or Position	:	CEO
Name	:	MS. YANA ZILBERMAN
Credential	:
Telephone Number	:	818-877-4040

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	04/01/2025

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