Provider Demographics
NPI:1114936432
Name:LLS ACTUAL DIAGNOSTICS INC
Entity Type:Organization
Organization Name:LLS ACTUAL DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-798-2041
Mailing Address - Street 1:1546 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2657
Mailing Address - Country:US
Mailing Address - Phone:626-798-2041
Mailing Address - Fax:626-798-2046
Practice Address - Street 1:1546 E WASHINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2657
Practice Address - Country:US
Practice Address - Phone:626-798-2041
Practice Address - Fax:626-798-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG330Medicare ID - Type Unspecified