Provider Demographics
NPI:1619367679
Name:BIRDROCK
Entity Type:Organization
Organization Name:BIRDROCK
Other - Org Name:BIRD ROCK LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAJVARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-460-7775
Mailing Address - Street 1:8430 JUNIPER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1074
Mailing Address - Country:US
Mailing Address - Phone:858-217-5918
Mailing Address - Fax:858-789-9580
Practice Address - Street 1:8430 JUNIPER CREEK LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1074
Practice Address - Country:US
Practice Address - Phone:858-217-5918
Practice Address - Fax:858-789-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory