Provider Demographics
NPI:1558520122
Name:BIOMED DIAGNOSTIC LABORATORIES, INC
Entity type:Organization
Organization Name:BIOMED DIAGNOSTIC LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAIANE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MKRTCHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-3800
Mailing Address - Street 1:1111 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2212
Mailing Address - Country:US
Mailing Address - Phone:818-244-3800
Mailing Address - Fax:818-247-3912
Practice Address - Street 1:1111 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2212
Practice Address - Country:US
Practice Address - Phone:818-244-3800
Practice Address - Fax:818-247-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1079646OtherCLIA