Ultimate DX Corp

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ULTIMATE DX CORP

Practice address

870 Vine St
Los Angeles, CA 90038-3724

Phone

(800) 799-7248

Fax

(818) 741-9500

NPI assigned

Jan 28, 2020

Organization subpart

No

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

Authorized official

Name

Ali Busheri

Title

Chief Operating Officer

Phone

(818) 668-7272

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1580169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1609407725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 VINE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900383724",
            "telephone_number": "800-799-7248",
            "fax_number": "818-741-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 VINE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900383724",
            "telephone_number": "800-799-7248",
            "fax_number": "818-741-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE DX CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-28",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A",
        "authorized_official_last_name": "BUSHERI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "818-668-7272"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ultimate Lifestyle Center
• Ultimate Lifestyle Center
• Ultimate Medical Supply Inc.

• 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 Feb 16, 2021; 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.