Provider Demographics
NPI:1669411054
Name:RELIABLE DIAGNOSTICS SERVICES, INC.
Entity type:Organization
Organization Name:RELIABLE DIAGNOSTICS SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YEVGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-737-0286
Mailing Address - Street 1:30 N. RAYMOND AVE
Mailing Address - Street 2:SUITE NUMBER 208
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103
Mailing Address - Country:US
Mailing Address - Phone:626-737-0286
Mailing Address - Fax:888-432-1787
Practice Address - Street 1:30 N. RAYMOND AVE
Practice Address - Street 2:SUITE NUMBER 208
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103
Practice Address - Country:US
Practice Address - Phone:626-737-0286
Practice Address - Fax:888-432-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG554Medicare PIN
CATG554Medicare ID - Type UnspecifiedIDTF