Provider Demographics
NPI:1366190688
Name:SPRING DIAGNOSTICS LLC
Entity type:Organization
Organization Name:SPRING DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHREIS-KABBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-363-7291
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-0609
Mailing Address - Country:US
Mailing Address - Phone:424-363-7291
Mailing Address - Fax:
Practice Address - Street 1:3848 DEL AMO BLVD STE 303
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7714
Practice Address - Country:US
Practice Address - Phone:424-363-7291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory