Provider Demographics
NPI:1043352586
Name:ALPHA CLINICAL LABORATORY, INC.
Entity Type:Organization
Organization Name:ALPHA CLINICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:AROUTIOUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-729-0927
Mailing Address - Street 1:3021 N SAN FERNANDO BLVD
Mailing Address - Street 2:#C
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4702
Mailing Address - Country:US
Mailing Address - Phone:818-729-0927
Mailing Address - Fax:818-729-0961
Practice Address - Street 1:3021 N SAN FERNANDO BLVD
Practice Address - Street 2:#C
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4702
Practice Address - Country:US
Practice Address - Phone:818-729-0927
Practice Address - Fax:818-729-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11729291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB99149FMedicaid
CAZZZ05242ZOtherBLUE SHEILD ID NUMBER