Organization
BIOMED LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AHSAN BASEER (AUTHORIZED PERSONNEL)
(714) 493-1224
Entity
Organization
Contact information
Practice address
4628 SAN FERNANDO RD, GLENDALE, CA 91204-1822
(818) 334-3244
(818) 334-3255
Mailing address
4628 SAN FERNANDO RD, GLENDALE, CA 91204-1822
(818) 334-3244
(818) 334-3255
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2234415
CLIA ID
CA
01
—
CLF-90004904
CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE
CA
Enumeration date
10/12/2021
Last updated
10/12/2021
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