Provider Demographics
NPI:1821091067
Name:ABACUS BUSINESS CORPORATION GROUP INC.
Entity Type:Organization
Organization Name:ABACUS BUSINESS CORPORATION GROUP INC.
Other - Org Name:AMERICAN BIO-CLINICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-222-6688
Mailing Address - Street 1:2730 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3321
Mailing Address - Country:US
Mailing Address - Phone:323-222-6688
Mailing Address - Fax:323-222-3388
Practice Address - Street 1:2730 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3321
Practice Address - Country:US
Practice Address - Phone:323-222-6688
Practice Address - Fax:323-222-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104749-60291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB04154FMedicaid
CALAB04154FMedicaid