Organization
EXPRESS DIAGNOSTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROMAN SHAYEVICH (PRESIDENT)
(818) 783-6107
Entity
Organization
Contact information
Practice address
15130 VENTURA BLVD, STE 221, SHERMAN OAKS, CA 91403-3372
(818) 783-6107
(866) 241-3280
Mailing address
15130 VENTURA BLVD, STE 221, SHERMAN OAKS, CA 91403-3372
(818) 783-6107
(866) 241-3280
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
134513-57
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ08080Z
BLUE SHIELD OF CA
CA
Enumeration date
06/20/2005
Last updated
08/22/2020
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