Provider Demographics
NPI:1073101028
Name:QUICKMED DIAGNOSTIC, INC.
Entity Type:Organization
Organization Name:QUICKMED DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SAVVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-905-6441
Mailing Address - Street 1:5930 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4306
Mailing Address - Country:US
Mailing Address - Phone:310-905-6441
Mailing Address - Fax:213-559-0676
Practice Address - Street 1:5930 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4306
Practice Address - Country:US
Practice Address - Phone:310-905-6441
Practice Address - Fax:213-559-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2203729OtherCLIA ID
CACLF00354442OtherSTATE LAB LICENSE