Provider Demographics
NPI:1124608401
Name:JNL MOBILE ENTERPRISES LLC
Entity type:Organization
Organization Name:JNL MOBILE ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-246-2139
Mailing Address - Street 1:12029 GREENVEIL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0388
Mailing Address - Country:US
Mailing Address - Phone:915-246-2139
Mailing Address - Fax:
Practice Address - Street 1:6138 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2022
Practice Address - Country:US
Practice Address - Phone:915-246-2139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JNL MOBILE ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-12
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty