Lifeline Medical Laboratory Incorporated

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LIFELINE MEDICAL LABORATORY INCORPORATED

Practice address

10509 Burbank Blvd
North Hollywood, CA 91601-2219

Phone

(818) 579-4220

Fax

(818) 301-1916

NPI assigned

Oct 5, 2018

Organization subpart

No

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

Authorized official

Name

Juan Robles

Title

Owner

Phone

(818) 579-4220

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1538697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559433600000",
    "number": "1083189088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10509 BURBANK BLVD",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916012219",
            "telephone_number": "818-579-4220",
            "fax_number": "818-301-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10509 BURBANK BLVD",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916012219",
            "telephone_number": "818-579-4220",
            "fax_number": "818-301-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE MEDICAL LABORATORY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-05",
        "last_updated": "2019-06-02",
        "status": "A",
        "authorized_official_last_name": "ROBLES",
        "authorized_official_first_name": "JUAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-579-4220"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINICAL LABORATORY LICENSE",
            "identifier": "CLF00333135",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "O5D1039663",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in North Hollywood, CA
• Providers in North Hollywood, 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 Jun 2, 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.