1548377914 NPI number — NOHO CLINICAL LABORATORIES INC

Table of content: (NPI 1548377914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548377914 NPI number — NOHO CLINICAL LABORATORIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOHO 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:
1548377914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11024 MAGNOLIA BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
NORTH HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91601-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-487-2900
Provider Business Mailing Address Fax Number:
818-487-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11024 MAGNOLIA BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-487-2900
Provider Business Practice Location Address Fax Number:
818-487-0800
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DMYTRIIEV
Authorized Official First Name:
OLEKSANDR
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
818-487-2900

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF333110 , 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)

  • Identifier: 05D1056363 . This is a "CLIA #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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