Provider Demographics
NPI:1982749628
Name:STAT DIAGNOSTIC SERVICE, INC.
Entity Type:Organization
Organization Name:STAT DIAGNOSTIC SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:562-761-7208
Mailing Address - Street 1:7803 ALDERDALE ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2608
Mailing Address - Country:US
Mailing Address - Phone:562-928-1719
Mailing Address - Fax:
Practice Address - Street 1:11411 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5003
Practice Address - Country:US
Practice Address - Phone:562-622-1002
Practice Address - Fax:562-622-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2597996291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory