Healthcare Provider Details

I. General information

NPI: 1073099602
Provider Name (Legal Business Name): JPROLABS2GO,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 CANYON BLUFF CT
ROSHARON TX
77583-2090
US

IV. Provider business mailing address

5502 CANYON BLUFF CT
ROSHARON TX
77583-2090
US

V. Phone/Fax

Practice location:
  • Phone: 832-965-6286
  • Fax: 281-595-7621
Mailing address:
  • Phone: 832-965-6286
  • Fax: 281-595-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHELLE MOORE JOHNSON
Title or Position: OWNER
Credential: PHLEBOMOTIST
Phone: 832-965-6286