Provider Demographics
NPI:1770633851
Name:HEALTHY LIFE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:HEALTHY LIFE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GENNADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-528-0606
Mailing Address - Street 1:1930 WILSHIRE BLVD STE 1209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3622
Mailing Address - Country:US
Mailing Address - Phone:213-413-2010
Mailing Address - Fax:
Practice Address - Street 1:1930 WILSHIRE BLVD STE 1209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3622
Practice Address - Country:US
Practice Address - Phone:213-413-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory