Provider Demographics
NPI:1659900439
Name:MEDEX LABORATORY INC
Entity Type:Organization
Organization Name:MEDEX LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-241-8169
Mailing Address - Street 1:704 S VICTORY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2471
Mailing Address - Country:US
Mailing Address - Phone:747-241-8169
Mailing Address - Fax:747-241-8198
Practice Address - Street 1:704 S VICTORY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2471
Practice Address - Country:US
Practice Address - Phone:747-241-8169
Practice Address - Fax:747-241-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory