Provider Demographics
NPI:1912867615
Name:AXIS CLINICAL LABORATORY LLC
Entity type:Organization
Organization Name:AXIS CLINICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAT SADEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-962-9523
Mailing Address - Street 1:210 W 1ST ST STE 215
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-8217
Mailing Address - Country:US
Mailing Address - Phone:310-962-9523
Mailing Address - Fax:310-962-9523
Practice Address - Street 1:210 W 1ST ST STE 215
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-8217
Practice Address - Country:US
Practice Address - Phone:310-962-9523
Practice Address - Fax:310-962-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-14
Last Update Date:2025-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory