Provider Demographics
NPI:1285936765
Name:EXPRESS RELIABLE DIAGNOSTIC INC
Entity type:Organization
Organization Name:EXPRESS RELIABLE DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-293-8049
Mailing Address - Street 1:19634 VENTURA BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2995
Mailing Address - Country:US
Mailing Address - Phone:818-293-8049
Mailing Address - Fax:818-708-2167
Practice Address - Street 1:19634 VENTURA BLVD STE 315
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2995
Practice Address - Country:US
Practice Address - Phone:818-293-8049
Practice Address - Fax:818-708-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory