Physicians Immunodiagnostic Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

19-1079 Issued in CA

Legal business name

PHYSICIANS IMMUNODIAGNOSTIC LABORATORY, INC.

Practice address

512 S Verdugo Dr
Burbank, CA 91502-2344

Phone

(818) 955-8477

Fax

(877) 940-1978

NPI assigned

Apr 20, 2006

Last updated

Aug 20, 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

Alfred Younan Ramzi

Title

Cfo

Phone

(818) 955-8477

Specialties & licenses 2

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": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1548225428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 S VERDUGO DR",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915022344",
            "telephone_number": "818-955-8477",
            "fax_number": "877-940-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 S VERDUGO DR",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915022344",
            "telephone_number": "818-955-8477",
            "fax_number": "877-940-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS IMMUNODIAGNOSTIC LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "RAMZI",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "YOUNAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "818-955-8477"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "19-1079",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB87857F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ51362Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Samantha Phung, DO
• Wa Sai Phung, PHARM.D.
• Florinda Mailom Piano, MD
• Anna Agnieszka Piaseczna, FNP
• Miles Reuben Picus, MS, CGC
• Joy Pieri, LCSW
• Pierre Manukian, M.D., Inc.

• Clinical Medical Laboratory in Burbank, CA
• Providers in Burbank, 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 20, 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.