Out PT Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

OUT PT LAB LLC

Practice address

600 W Broadway
Glendale, CA 91204-1022

Phone

(626) 241-2749

NPI assigned

Mar 9, 2023

Last updated

Aug 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Emmanuel Banjarjian, CLS, MLS (ASCP)

Title

Director

Phone

(626) 241-2749

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

Locations

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1093415812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 S HILL ST STE 210",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900141756",
            "telephone_number": "626-241-2749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W BROADWAY",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041022",
            "telephone_number": "626-241-2749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUT PT LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-09",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "BANJARJIAN",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "626-241-2749",
        "authorized_official_credential": "CLS, MLS (ASCP)"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Micah Summer Otazu
• Roza Ouladi, DC
• Eddie Oulashian, DC
• Laura Jacqueline Ourfalian, MSW
• Sareen Ourfalian
• Lillyt Ouzounian, OD
• Mary Ovakyan, PHARMD
• Razmik Ovanespour, DDS
• Alenoush Ovasapyan, LVN
• Shake Ovasapyan, NP

• Clinical Medical Laboratory in Glendale, CA
• Providers in Glendale, 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 7, 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.