Provider Demographics
NPI:1427728815
Name:ANANDA ANALYTICAL LABORATORIES LLC
Entity type:Organization
Organization Name:ANANDA ANALYTICAL LABORATORIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-414-4222
Mailing Address - Street 1:101 S 1ST ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1928
Mailing Address - Country:US
Mailing Address - Phone:562-414-4222
Mailing Address - Fax:
Practice Address - Street 1:101 S 1ST ST STE 1000
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1928
Practice Address - Country:US
Practice Address - Phone:562-414-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2217697OtherCLIA