Provider Demographics
NPI:1134433667
Name:ZOOMMED INC
Entity type:Organization
Organization Name:ZOOMMED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-809-4965
Mailing Address - Street 1:11490 BURBANK BLVD
Mailing Address - Street 2:STE 1D
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2389
Mailing Address - Country:US
Mailing Address - Phone:877-809-4965
Mailing Address - Fax:
Practice Address - Street 1:58 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7020
Practice Address - Country:US
Practice Address - Phone:877-809-4965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40D0690736291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory