Healthcare Provider Details

I. General information

NPI: 1073367389
Provider Name (Legal Business Name): MNM LABORATORY CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CYPRESS STATION DR STE 285
HOUSTON TX
77090-1689
US

IV. Provider business mailing address

32067 AUGUST WOODS WAY
CONROE TX
77385-2029
US

V. Phone/Fax

Practice location:
  • Phone: 424-999-8698
  • Fax:
Mailing address:
  • Phone: 310-418-6535
  • Fax:

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: MASHUD OGUNLAJA
Title or Position: OWNER
Credential:
Phone: 424-999-8698