Provider Demographics
NPI:1245402585
Name:AMERICAN PREMIER LABORATORY
Entity Type:Organization
Organization Name:AMERICAN PREMIER LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:AIDINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-693-6301
Mailing Address - Street 1:6850 CANBY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4310
Mailing Address - Country:US
Mailing Address - Phone:818-693-6301
Mailing Address - Fax:
Practice Address - Street 1:6850 CANBY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4310
Practice Address - Country:US
Practice Address - Phone:818-693-6301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF328586291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0993450Medicare PIN