Organization
LIFELINE MEDICAL LABORATORY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN ROBLES (OWNER)
(818) 579-4220
Entity
Organization
Contact information
Practice address
10509 BURBANK BLVD, NORTH HOLLYWOOD, CA 91601-2219
(818) 579-4220
(818) 301-1916
Mailing address
10509 BURBANK BLVD, NORTH HOLLYWOOD, CA 91601-2219
(818) 579-4220
(818) 301-1916
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CLF00333135
CLINICAL LABORATORY LICENSE
CA
01
—
O5D1039663
CLIA
CA
Enumeration date
10/05/2018
Last updated
06/02/2019
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