1043216682 NPI number — PRIMEX CLINICAL LABORATORIES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043216682 NPI number — PRIMEX CLINICAL LABORATORIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMEX CLINICAL LABORATORIES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043216682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16742 STAGG ST
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91406-1641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-961-7870
Provider Business Mailing Address Fax Number:
818-779-1351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16742 STAGG ST
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91406-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-961-7870
Provider Business Practice Location Address Fax Number:
818-779-1351
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MALEKIANS
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
818-779-0130

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF11195 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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