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General NPI Number Information
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NPI Number | 1861566762
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Entity Type | Organization
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Legal Business Name | JAMELLOW LLC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1131 E MAIN ST SUITE 109
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City | TUSTIN
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State | CA
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Zip | 92780-4416
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Country | US
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Telephone | 951-205-7103
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Fax |
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Provider Business Mailing Address
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Address Line | 27574 COMMERCE CENTER DR SUITE 236
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City | TEMECULA
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State | CA
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Zip | 92590-2500
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Country | US
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Telephone | 951-695-9648
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Fax | 951-695-3949
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Authorized Official
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Title or Position | PARTNER
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Name | DR. LUDLOW CREARY
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Credential | MD
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Telephone | 951-695-9648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | C24667
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License Number State | CA
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