Provider Demographics
NPI:1245191881
Name:DAVA DIAGNOSTIC LAB INC
Entity type:Organization
Organization Name:DAVA DIAGNOSTIC LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVITYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-568-3115
Mailing Address - Street 1:703 E CHESTNUT ST APT 10
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2208
Mailing Address - Country:US
Mailing Address - Phone:818-568-3115
Mailing Address - Fax:818-568-3115
Practice Address - Street 1:13610 MIDWAY RD STE 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4347
Practice Address - Country:US
Practice Address - Phone:214-258-6965
Practice Address - Fax:214-258-6965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty