Provider Demographics
NPI:1164143236
Name:JENTAL LABZ LLC
Entity Type:Organization
Organization Name:JENTAL LABZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSETTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-377-3276
Mailing Address - Street 1:418 W JUDGE PEREZ DR STE D
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4972
Mailing Address - Country:US
Mailing Address - Phone:504-377-3276
Mailing Address - Fax:504-766-7152
Practice Address - Street 1:418 W JUDGE PEREZ DR STE D
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4972
Practice Address - Country:US
Practice Address - Phone:504-377-3276
Practice Address - Fax:504-766-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1225509938Medicaid