Provider Demographics
NPI:1114431087
Name:SIGNAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SIGNAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:MESHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-262-7300
Mailing Address - Street 1:8885 VENICE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8885 VENICE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3242
Practice Address - Country:US
Practice Address - Phone:323-963-3450
Practice Address - Fax:415-534-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
CACLF00346419291U00000X
05D2081405291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory