Provider Demographics
NPI:1083233407
Name:SUPER LAB DIAGNOSTICS INC
Entity Type:Organization
Organization Name:SUPER LAB DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARSHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SARUKHANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-423-3854
Mailing Address - Street 1:11755 VICTORY BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3481
Mailing Address - Country:US
Mailing Address - Phone:818-423-3854
Mailing Address - Fax:
Practice Address - Street 1:11755 VICTORY BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3481
Practice Address - Country:US
Practice Address - Phone:818-423-3854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty