Healthcare Provider Details

I. General information

NPI: 1851573471
Provider Name (Legal Business Name): J H CLINICAL LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W MANCHESTER BLVD
INGLEWOOD CA
90305-2514
US

IV. Provider business mailing address

PO BOX 2417
INGLEWOOD CA
90305-0417
US

V. Phone/Fax

Practice location:
  • Phone: 323-750-0640
  • Fax: 323-777-6446
Mailing address:
  • Phone: 323-750-0640
  • Fax: 323-777-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. IREY DOLORES HILSMAN
Title or Position: OWNER
Credential:
Phone: 323-750-0640