Privilege DX Medical Laboratories, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

3889342 Issued in CA

Legal business name

PRIVILEGE DX MEDICAL LABORATORIES, INC.

Practice address

10133 Riverside Dr
Toluca Lake, CA 91602-2533

Phone

(747) 203-1614

Fax

(747) 205-2042

NPI assigned

Jul 27, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Onick Bagdassarian, OWNER

Title

President

Phone

(747) 203-1614

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563926400000",
    "number": "1003369968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10133 RIVERSIDE DR",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022533",
            "telephone_number": "747-203-1614",
            "fax_number": "747-205-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10133 RIVERSIDE DR",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022533",
            "telephone_number": "747-203-1614",
            "fax_number": "747-205-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVILEGE DX MEDICAL LABORATORIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-27",
        "last_updated": "2019-07-24",
        "status": "A",
        "authorized_official_last_name": "BAGDASSARIAN",
        "authorized_official_first_name": "ONICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "747-203-1614",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "3889342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Toluca Lake, CA
• Providers in Toluca Lake, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.