Organization
UNIVERSITY OF SOUTHERN CALIFORNIA
Active
Parent organization
UNIVERSITY OF SOUTHERN CALIFORNIA
Other names
USC IMMUNOHISTOCHEMISTRY LABORATORY
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF SOUTHERN CALIFORNIA
Authorized official
MR. TODD DICKEY (SR VP ADMINISTRATION)
(213) 740-8184
Entity
Organization
Contact information
Practice address
2011 ZONAL AVE, HRM 308 AND 310, LOS ANGELES, CA 90089-0110
(323) 442-1156
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-1156
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1033784
CLIA NUMBER
CA
01
—
690000015
MEDICARE RAILROAD
CA
01
—
CLF332197
STATE LIC
—
05
—
LAB33784F
—
CA
Enumeration date
06/22/2007
Last updated
04/30/2015
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