Provider Demographics
NPI:1568606796
Name:DX'S CLINICAL LABORATORIES
Entity Type:Organization
Organization Name:DX'S CLINICAL LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VITALINA
Authorized Official - Middle Name:MIKHAYLOVNA
Authorized Official - Last Name:SHCHERBYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-557-7744
Mailing Address - Street 1:1611 N SAN FERNANDO BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4152
Mailing Address - Country:US
Mailing Address - Phone:818-557-7744
Mailing Address - Fax:
Practice Address - Street 1:1611 N SAN FERNANDO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4152
Practice Address - Country:US
Practice Address - Phone:818-557-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1064287OtherCLIA