Provider Demographics
NPI:1225554843
Name:GLOBAL DIAGNOSTIC LAB , INC
Entity Type:Organization
Organization Name:GLOBAL DIAGNOSTIC LAB , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-422-8141
Mailing Address - Street 1:825 WESTERN AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2376
Mailing Address - Country:US
Mailing Address - Phone:818-649-1408
Mailing Address - Fax:818-649-1410
Practice Address - Street 1:26 N OAK AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3519
Practice Address - Country:US
Practice Address - Phone:626-577-2711
Practice Address - Fax:626-577-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF342352291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory