Provider Demographics
NPI:1467497552
Name:JACOB POGOSIAN
Entity Type:Organization
Organization Name:JACOB POGOSIAN
Other - Org Name:MEDEX LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:POGOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-265-0001
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF333109291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory