Provider Demographics
NPI:1366760522
Name:AMBS DIAGNOSTICS
Entity type:Organization
Organization Name:AMBS DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANCONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-792-4700
Mailing Address - Street 1:141 S LAKE AVE # 104
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2673
Mailing Address - Country:US
Mailing Address - Phone:626-792-4700
Mailing Address - Fax:
Practice Address - Street 1:141 S LAKE AVE # 104
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2673
Practice Address - Country:US
Practice Address - Phone:626-792-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory