Provider Demographics
NPI:1245756212
Name:PRIME LAB, INC.
Entity Type:Organization
Organization Name:PRIME LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:POGOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-219-9690
Mailing Address - Street 1:31344 VIA COLINAS
Mailing Address - Street 2:UNITE 104
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:818-485-1004
Mailing Address - Fax:818-485-1005
Practice Address - Street 1:31344 VIA COLINAS
Practice Address - Street 2:UNITE 104
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:818-485-1004
Practice Address - Fax:818-485-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF347739291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory