Provider Demographics
NPI:1851573471
Name:J H CLINICAL LABORATORY
Entity type:Organization
Organization Name:J H CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IREY
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:HILSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-750-0640
Mailing Address - Street 1:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-0417
Mailing Address - Country:US
Mailing Address - Phone:323-750-0640
Mailing Address - Fax:323-777-6446
Practice Address - Street 1:2220 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2514
Practice Address - Country:US
Practice Address - Phone:323-750-0640
Practice Address - Fax:323-777-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30895ZMedicaid
CAX058540Medicare PIN