Provider Demographics
NPI:1609407725
Name:ULTIMATE DX CORP
Entity Type:Organization
Organization Name:ULTIMATE DX CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-668-7272
Mailing Address - Street 1:870 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3724
Mailing Address - Country:US
Mailing Address - Phone:800-799-7248
Mailing Address - Fax:818-741-9500
Practice Address - Street 1:870 VINE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3724
Practice Address - Country:US
Practice Address - Phone:800-799-7248
Practice Address - Fax:818-741-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory