Provider Demographics
NPI:1346467354
Name:INTERNATIONAL MEDICAL LABORATORY
Entity Type:Organization
Organization Name:INTERNATIONAL MEDICAL LABORATORY
Other - Org Name:PACIFIC MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARGHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-972-2222
Mailing Address - Street 1:15 CORPORATE PARK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5119
Mailing Address - Country:US
Mailing Address - Phone:714-972-2222
Mailing Address - Fax:714-972-2221
Practice Address - Street 1:15 CORPORATE PARK
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5119
Practice Address - Country:US
Practice Address - Phone:714-972-2222
Practice Address - Fax:714-972-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAX558861291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX558861OtherPTAN
CALAB58861FMedicaid