21St Century Diagnostic Laboratory, Inc.
Organization Active NPI Clinical Medical Laboratory · Burbank, CA
NPI 1407861990 · NPPES record last updated Aug 3, 2022
Key facts
- NPI
- 1407861990
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 05D0956168 (CA)
- Legal business name
- 21ST CENTURY DIAGNOSTIC LABORATORY, INC.
- Practice address
- 121 N Victory Blvd
Burbank, CA 91502-1837 - Phone
- (323) 660-9480
- NPI assigned
- Jul 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Hasmik Melkumyan, CLS
- Title
- Sercretary
- Phone
- (323) 660-9480
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0956168 | 21St Century Diagnostic Laboratory | Compliance | Apr 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060511000376 | CA | Part B Supplier - Independent Clinical Laboratory | 2769493220 | Practice locations: Burbank, CA |
National Provider Directory
Locations
121 N Victory Blvd
Burbank, CA 91502
Phone (323) 660-9480
3110 Los Feliz Blvd
Los Angeles, CA 90039
Phone (213) 328-3549
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 05D0956168 | CA | Yes |
Addresses
Primary practice location
121 N Victory Blvd
Burbank, CA 91502-1837
Mailing address
121 N Victory Blvd
Burbank, CA 91502-1837
Phone (323) 660-9480
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LAB56168F | Medicaid | CA |
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All providers in Burbank, CA · Clinical Medical Laboratory in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.