Provider Demographics
NPI:1013917020
Name:INTER SCIENCE INSTITUTE
Entity Type:Organization
Organization Name:INTER SCIENCE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-677-3322
Mailing Address - Street 1:944 W HYDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3308
Mailing Address - Country:US
Mailing Address - Phone:310-677-3322
Mailing Address - Fax:310-677-2846
Practice Address - Street 1:944 W HYDE PARK BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-3308
Practice Address - Country:US
Practice Address - Phone:310-677-3322
Practice Address - Fax:310-677-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 1801291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ49545ZMedicaid
05L0008967Medicare ID - Type Unspecified