Provider Demographics
NPI:1174502322
Name:JNV MEDICAL DIAGNOSTICS
Entity Type:Organization
Organization Name:JNV MEDICAL DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RESPIRATORY THERAPIS
Authorized Official - Phone:909-915-4544
Mailing Address - Street 1:1429 LANFAIR ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2632
Mailing Address - Country:US
Mailing Address - Phone:909-915-4544
Mailing Address - Fax:909-307-8302
Practice Address - Street 1:1429 LANFAIR ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2632
Practice Address - Country:US
Practice Address - Phone:909-915-4544
Practice Address - Fax:909-307-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000217762278P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary DiagnosticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01752ZMedicare ID - Type UnspecifiedIDTF