100 Plaza Clinical Lab Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF519 Issued in CA

Legal business name

100 PLAZA CLINICAL LAB INC

Doing business as

100 Plaza Clinical Lab

Practice address

100 UCLA Medical PLZ
Suite #245
Los Angeles, CA 90024-6970

Phone

(310) 208-0099

Fax

(310) 208-0963

NPI assigned

Aug 30, 2006

Last updated

Mar 27, 2009By 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

Dr. Bahram Parsa, M.D., PH.D.NPI 1013250927

Title

Director

Phone

(310) 208-0099

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• 100 PLAZA CLINICAL LAB Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bahram Parsa, M.D., PH D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Los Angeles, CA
  • NPI 1013250927
  NPD (past) Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238112000000",
    "number": "1194834028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 UCLA MEDICAL PLZ",
            "address_2": "SUITE #245",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900246970",
            "telephone_number": "310-208-0099",
            "fax_number": "310-208-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 UCLA MEDICAL PLZ",
            "address_2": "SUITE #245",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900246970",
            "telephone_number": "310-208-0099",
            "fax_number": "310-208-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "100 PLAZA CLINICAL LAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-03-27",
        "status": "A",
        "authorized_official_last_name": "PARSA",
        "authorized_official_first_name": "BAHRAM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "310-208-0099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB58794F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "100 PLAZA CLINICAL LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Los Angeles, CA
• Providers in Los Angeles, 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 Mar 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.