Organization
PHYSICIANS IMMUNODIAGNOSTIC LABORATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED YOUNAN RAMZI (CFO)
(818) 955-8477
Entity
Organization
Contact information
Practice address
512 S VERDUGO DR, BURBANK, CA 91502-2344
(818) 955-8477
(877) 940-1978
Mailing address
512 S VERDUGO DR, BURBANK, CA 91502-2344
(818) 955-8477
(877) 940-1978
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
19-1079
CA
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAB87857F
—
CA
01
—
ZZZ51362Z
BLUE SHIELD
CA
Enumeration date
04/20/2006
Last updated
08/20/2024
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