Provider Demographics
NPI:1215400650
Name:DYNAMIC HEALTH LABS
Entity Type:Organization
Organization Name:DYNAMIC HEALTH LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-595-1000
Mailing Address - Street 1:516 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1306
Mailing Address - Country:US
Mailing Address - Phone:323-920-0448
Mailing Address - Fax:323-380-7991
Practice Address - Street 1:516 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1306
Practice Address - Country:US
Practice Address - Phone:323-920-0448
Practice Address - Fax:323-380-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory