Provider Demographics
NPI:1699942565
Name:DISCOVERY MEDICAL LABORATORY
Entity type:Organization
Organization Name:DISCOVERY MEDICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KLARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-666-2526
Mailing Address - Street 1:3404 GLENDALE BLVD # B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1815
Mailing Address - Country:US
Mailing Address - Phone:323-666-2526
Mailing Address - Fax:
Practice Address - Street 1:3404 GLENDALE BLVD # B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1815
Practice Address - Country:US
Practice Address - Phone:323-666-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D1081778291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory