Organization
PROFESSIONAL CLINICAL LABORATORY
Active
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
Update your record
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