Provider Demographics
NPI:1184809964
Name:BLOOD TEK, INC
Entity type:Organization
Organization Name:BLOOD TEK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAIK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARETIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-956-5877
Mailing Address - Street 1:1016 E BROADWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4532
Mailing Address - Country:US
Mailing Address - Phone:818-956-5877
Mailing Address - Fax:
Practice Address - Street 1:1016 E BROADWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4532
Practice Address - Country:US
Practice Address - Phone:818-956-5877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAV661Medicare PIN