Provider Demographics
NPI:1881736650
Name:R & B MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:R & B MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-324-3780
Mailing Address - Street 1:6700 VALJEAN AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:818-582-3189
Mailing Address - Fax:818-849-5442
Practice Address - Street 1:6700 VALJEAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5818
Practice Address - Country:US
Practice Address - Phone:818-582-3189
Practice Address - Fax:818-849-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF322706291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D0938253OtherCLIA
CALAB38253FMedicaid
05D0938253OtherCLIA