Healthcare Provider Details

I. General information

NPI: 1770459588
Provider Name (Legal Business Name): ON TIME SPECIMEN LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11970 WILCREST DR STE 102
HOUSTON TX
77031-1923
US

IV. Provider business mailing address

11970 WILCREST DR STE 102
HOUSTON TX
77031-1923
US

V. Phone/Fax

Practice location:
  • Phone: 346-735-4925
  • Fax:
Mailing address:
  • Phone: 346-735-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: MS. ANISSA CANTREL RAINER
Title or Position: OWNER
Credential:
Phone: 346-735-4925