Epicwave Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EPICWAVE LABORATORY LLC

Practice address

16114 Sherman Way
Van Nuys, CA 91406-3907

Phone

(800) 961-6747

NPI assigned

Mar 7, 2022

Organization subpart

No

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

Authorized official

Name

Marc Benedict Enriquez Bernaldez, MLS(ASCP)CM

Title

Owner

Phone

(800) 961-6747

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• EpicWave Laboratory Doing business as

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

Locations

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

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723161600000",
    "number": "1023765385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16114 SHERMAN WAY",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914063907",
            "telephone_number": "800-961-6747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16114 SHERMAN WAY",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914063907",
            "telephone_number": "800-961-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPICWAVE LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-07",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A",
        "authorized_official_last_name": "BERNALDEZ",
        "authorized_official_first_name": "MARC BENEDICT",
        "authorized_official_middle_name": "ENRIQUEZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-961-6747",
        "authorized_official_credential": "MLS(ASCP)CM"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2308399",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABORATORY LICENSE",
            "identifier": "CLR-90006743",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2262840",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABORATORY LICENSE",
            "identifier": "CDF-90013520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EpicWave Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bellin Enriquez
• Michael V Enriquez, LMFT
• Ensieh Mazaheri DDS Inc
• Rita Enwerem-Bradley
• Epic Mobil Ultrasound Imaging Inc
• Epione Hospice Care, Inc.
• Fallon Melissa Epstein-Galligan
• Mark J Epstein, M.D.
• Equilibrium Health Serivces Inc
• Equinox Hospice Inc.

• Clinical Medical Laboratory in Van Nuys, CA
• Providers in Van Nuys, 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 Aug 9, 2024; 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.