Executive Health Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EXECUTIVE HEALTH LABORATORY

Practice address

19234 Vanowen St Ste B
Reseda, CA 91335-5000

Phone

(424) 265-9992

NPI assigned

Nov 13, 2021

Last updated

Nov 13, 2021By 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

Ms. Masih Noor

Title

Ceo

Phone

(424) 265-9992

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1636761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636761600000",
    "number": "1972269959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17412 VENTURA BLVD # 422",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913163827",
            "telephone_number": "424-265-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19234 VANOWEN ST STE B",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913355000",
            "telephone_number": "424-265-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE HEALTH LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-13",
        "last_updated": "2021-11-13",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "NOOR",
        "authorized_official_first_name": "MASIH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "424-265-9992",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Reseda, CA
• Providers in Reseda, 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 Nov 13, 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.