Provider Demographics
NPI:1548377914
Name:NOHO CLINICAL LABORATORIES INC
Entity type:Organization
Organization Name:NOHO CLINICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:DMYTRIIEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-487-2900
Mailing Address - Street 1:11024 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3810
Mailing Address - Country:US
Mailing Address - Phone:818-487-2900
Mailing Address - Fax:818-487-0800
Practice Address - Street 1:11024 MAGNOLIA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3810
Practice Address - Country:US
Practice Address - Phone:818-487-2900
Practice Address - Fax:818-487-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF333110291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1056363OtherCLIA #