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Organization

PROFESSIONAL CLINICAL LABORATORY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHN SHAYEFAR (PRESIDENT)
(310) 360-0022
Entity
Organization

Contact information

Practice address
432 S SAN VICENTE BLVD # 200A, SUITE 200, LOS ANGELES, CA 90048-4183
(310) 360-0066
(310) 360-0302
Mailing address
432 S SAN VICENTE BLVD, SUITE 200A, LOS ANGELES, CA 90048-4183
(310) 360-0022
(310) 360-0302

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D2048878
CA

Other

Enumeration date
02/11/2009
Last updated
06/25/2013
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