Provider Demographics
NPI:1073268322
Name:STAR MEDICAL LABORATORY INC
Entity Type:Organization
Organization Name:STAR MEDICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHEVLAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-394-9533
Mailing Address - Street 1:8588 TELFAIR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3145
Mailing Address - Country:US
Mailing Address - Phone:818-394-9533
Mailing Address - Fax:
Practice Address - Street 1:8588 TELFAIR AVE STE B
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3145
Practice Address - Country:US
Practice Address - Phone:818-394-9533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory