=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376205120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J&J TESTING ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2021
-----------------------------------------------------
Last Update Date | 10/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19660 ARCADIA ST
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92881-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-367-6818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6483 HUNTER RD
-----------------------------------------------------
City | EASTVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92880-0797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-367-6818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JAMIL SYED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-367-6818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247ZC0005X
-----------------------------------------------------
Taxonomy Name | Clinical Laboratory Director (Non-physician)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------