Provider Demographics
NPI:1235360777
Name:BARSEGIAN, ROUBEN
Entity Type:Individual
Prefix:MR
First Name:ROUBEN
Middle Name:
Last Name:BARSEGIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DBA
Other - Middle Name:MEDEX
Other - Last Name:LABORATORIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5242 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2439
Mailing Address - Country:US
Mailing Address - Phone:818-265-0001
Mailing Address - Fax:818-265-0008
Practice Address - Street 1:5242 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2439
Practice Address - Country:US
Practice Address - Phone:818-265-0001
Practice Address - Fax:818-265-0008
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB6617575291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27-0611117OtherTIN #
CA05D1055209Medicare PIN