Provider Demographics
NPI:1932924420
Name:LENISES LAB SERVICE, LLC
Entity type:Organization
Organization Name:LENISES LAB SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:424-312-3078
Mailing Address - Street 1:438 E SPRUCE AVE UNIT 143
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-6374
Mailing Address - Country:US
Mailing Address - Phone:424-312-3078
Mailing Address - Fax:
Practice Address - Street 1:438 E SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-6379
Practice Address - Country:US
Practice Address - Phone:424-312-3078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty