Provider Demographics
NPI:1497802466
Name:BIXBY CLINICAL LABORATORY, INC.
Entity Type:Organization
Organization Name:BIXBY CLINICAL LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-508-9603
Mailing Address - Street 1:10523 BURBANK BLVD
Mailing Address - Street 2:#102
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2233
Mailing Address - Country:US
Mailing Address - Phone:818-508-9603
Mailing Address - Fax:818-508-9206
Practice Address - Street 1:10523 BURBANK BLVD
Practice Address - Street 2:#102
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2233
Practice Address - Country:US
Practice Address - Phone:818-508-9603
Practice Address - Fax:818-508-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF333543291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLIA 05D160923OtherCLINICAL LABORATORY