Provider Demographics
NPI:1437117140
Name:T. BENSYL CORPORATION
Entity Type:Organization
Organization Name:T. BENSYL CORPORATION
Other - Org Name:MTS CLINICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MILO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-901-9001
Mailing Address - Street 1:7625 HAYVENHURST AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1700
Mailing Address - Country:US
Mailing Address - Phone:818-901-9001
Mailing Address - Fax:818-376-1374
Practice Address - Street 1:7625 HAYVENHURST AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1700
Practice Address - Country:US
Practice Address - Phone:818-901-9001
Practice Address - Fax:818-376-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF4289291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0D0642836OtherCLIA
CACLF4289Medicaid
CACLF4289Medicaid