Organization
MEGAMED CLINICAL LABORATORIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAPOUR MOTAMEDI PH.D. (PRESIDENT)
(818) 654-0632
Entity
Organization
Contact information
Practice address
7302 CANBY AVE, RESEDA, CA 91335-3010
(818) 654-0632
(818) 654-0634
Mailing address
7302 CANBY AVE, RESEDA, CA 91335-3010
(818) 654-0632
(818) 654-0634
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CLF011639
STATE LICENSE
CA
05
—
LAB69790G
—
CA
01
—
ZZZ64202Z
BLUE SHIELD
CA
Enumeration date
10/13/2006
Last updated
09/12/2014
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