Provider Demographics
NPI:1619915352
Name:VENTURADIAGNOSTIC
Entity Type:Organization
Organization Name:VENTURADIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEVGENIY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-708-0071
Mailing Address - Street 1:18075 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3517
Mailing Address - Country:US
Mailing Address - Phone:818-708-0071
Mailing Address - Fax:818-708-8635
Practice Address - Street 1:18075 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3517
Practice Address - Country:US
Practice Address - Phone:818-708-0071
Practice Address - Fax:818-708-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory