Provider Demographics
NPI:1730834912
Name:NURA DIAGNOSTIC INC
Entity type:Organization
Organization Name:NURA DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GEMJIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-510-6189
Mailing Address - Street 1:900 VALLEY VIEW AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1976
Mailing Address - Country:US
Mailing Address - Phone:626-510-6189
Mailing Address - Fax:626-510-6258
Practice Address - Street 1:900 VALLEY VIEW AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1976
Practice Address - Country:US
Practice Address - Phone:626-510-6189
Practice Address - Fax:626-510-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2246783OtherCLIA ID
CACLF-90005524OtherCLINICAL AND PUBLIC HEALTH LABORATORY LICENSE