Provider Demographics
NPI:1467185819
Name:Q24 MOBILE LAB LLC
Entity Type:Organization
Organization Name:Q24 MOBILE LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-878-1192
Mailing Address - Street 1:1256 DUARTE RD
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2760
Mailing Address - Country:US
Mailing Address - Phone:888-878-1192
Mailing Address - Fax:818-295-3553
Practice Address - Street 1:1256 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2760
Practice Address - Country:US
Practice Address - Phone:888-878-1192
Practice Address - Fax:818-295-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory