Provider Demographics
NPI:1790352706
Name:JP EXPRESS LABORATORY, INC
Entity Type:Organization
Organization Name:JP EXPRESS LABORATORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-475-5923
Mailing Address - Street 1:935 S MOUNT VERNON AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3963
Mailing Address - Country:US
Mailing Address - Phone:909-645-8200
Mailing Address - Fax:909-347-7059
Practice Address - Street 1:935 S MOUNT VERNON AVE STE 109
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3963
Practice Address - Country:US
Practice Address - Phone:909-645-8200
Practice Address - Fax:909-347-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory