Organization
MOTION PICTURE AND TELEVISION FUND
Active
Other names
MOTION PICTURE AND TELEVISION FUND LABORATORY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID B TILLMAN MD (CEO/PRESIDENT)
(818) 876-1767
Entity
Organization
Contact information
Practice address
23388 MULHOLLAND DR, WOODLAND HILLS, CA 91364-2733
(818) 876-1050
(818) 591-1614
Mailing address
23388 MULHOLLAND DR, WOODLAND HILLS, CA 91364-2733
(818) 876-1050
(818) 591-1614
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 912
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0689437
CLIA
CA
Enumeration date
07/31/2009
Last updated
07/31/2009
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