Provider Demographics
NPI:1528619970
Name:COMMUNITY LABORATORY INC
Entity type:Organization
Organization Name:COMMUNITY LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANOONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-625-4643
Mailing Address - Street 1:1919 W 7TH ST UNIT L
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4103
Mailing Address - Country:US
Mailing Address - Phone:213-282-3599
Mailing Address - Fax:
Practice Address - Street 1:1919 W 7TH ST UNIT L
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4103
Practice Address - Country:US
Practice Address - Phone:213-282-3599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory