Provider Demographics
NPI:1851526495
Name:PASADENA LABORATORY SERVICES INC
Entity Type:Organization
Organization Name:PASADENA LABORATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MWATA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-284-1104
Mailing Address - Street 1:13547 VENTURA BLVD
Mailing Address - Street 2:SUITE 92
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 E WALNUT ST
Practice Address - Street 2:STE 136
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1893
Practice Address - Country:US
Practice Address - Phone:818-284-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty