Provider Demographics
NPI:1134825219
Name:IMMUNOLOGY DIAGNOSTICS LLC
Entity type:Organization
Organization Name:IMMUNOLOGY DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-444-1215
Mailing Address - Street 1:PO BOX 10655
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3655
Mailing Address - Country:US
Mailing Address - Phone:310-444-1215
Mailing Address - Fax:310-861-9004
Practice Address - Street 1:1735 STEWART ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4021
Practice Address - Country:US
Practice Address - Phone:310-444-1215
Practice Address - Fax:310-861-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory