Healthcare Provider Details

I. General information

NPI: 1376327007
Provider Name (Legal Business Name): 92192241
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 W WALNUT ST STE B
LAKE CHARLES LA
70601-5699
US

IV. Provider business mailing address

2918 CYPRESS ST
LAKE CHARLES LA
70601-8435
US

V. Phone/Fax

Practice location:
  • Phone: 337-292-0636
  • Fax:
Mailing address:
  • Phone: 337-292-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. LYELA MARIE LAMBERT
Title or Position: OWNER
Credential:
Phone: 337-292-0636