Provider Demographics
NPI:1912371709
Name:DIAMOND INTEGRATED COMPANY
Entity Type:Organization
Organization Name:DIAMOND INTEGRATED COMPANY
Other - Org Name:DIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:INFLUENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALUBI
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:301-583-0130
Mailing Address - Street 1:6005 LANDOVER RD
Mailing Address - Street 2:104B
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1145
Mailing Address - Country:US
Mailing Address - Phone:301-583-0130
Mailing Address - Fax:301-341-0860
Practice Address - Street 1:6005 LANDOVER RD
Practice Address - Street 2:104B
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1145
Practice Address - Country:US
Practice Address - Phone:301-583-0130
Practice Address - Fax:301-341-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory