Professional Clinical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

05D2048878 Issued in CA

Legal business name

PROFESSIONAL CLINICAL LABORATORY

Practice address

432 S San Vicente Blvd # 200a
Suite 200
Los Angeles, CA 90048-4183

Phone

(310) 360-0066

Fax

(310) 360-0302

NPI assigned

Feb 11, 2009

Organization subpart

No

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

Authorized official

Name

Mr. John Shayefar

Title

President

Phone

(310) 360-0022

Specialties & licenses 1

Addresses

Tax ID family

Professional Clinical Laboratory2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Clinical Laboratory

  • Clinical Medical Laboratory
  • Los Angeles, CA
  • NPI 1588004196
  NPD tax ID

Locations

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1881833036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 S SAN VICENTE BLVD",
            "address_2": "SUITE 200A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900484183",
            "telephone_number": "310-360-0022",
            "fax_number": "310-360-0302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 S SAN VICENTE BLVD # 200A",
            "address_2": "SUITE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900484183",
            "telephone_number": "310-360-0066",
            "fax_number": "310-360-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CLINICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "SHAYEFAR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-360-0022",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D2048878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prodynamics Inc.
• Lyudmila Proektor, ABO-NCLE
• Professional Action Medical Transport, Inc
• Professional Care Hospice and Home Health, Inc.
• Professional Clinical Laboratory
• Professional Concierge Nursing PC
• Professional Executive Business Services, Inc.
• Professional Imaging Network
• Professional Imaging Network Co
• Professional Neurological Care

• 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 Jun 25, 2013; 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.