Provider Demographics
NPI:1619176179
Name:DENIS SAVENKO
Entity Type:Organization
Organization Name:DENIS SAVENKO
Other - Org Name:CENTRAL COAST MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-815-2402
Mailing Address - Street 1:5632 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 333
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 N HEMLOCK CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1103
Practice Address - Country:US
Practice Address - Phone:918-815-2402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory