Provider Demographics
NPI:1649913351
Name:AA DIAGNOSTIC LAB
Entity type:Organization
Organization Name:AA DIAGNOSTIC LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASIRIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-222-3420
Mailing Address - Street 1:5535 BALBOA BLVD STE 229
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1559
Mailing Address - Country:US
Mailing Address - Phone:747-247-2071
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD STE 229
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1559
Practice Address - Country:US
Practice Address - Phone:747-247-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory