Provider Demographics
NPI:1821604505
Name:SHALONDA RENEE JOHNSON
Entity Type:Organization
Organization Name:SHALONDA RENEE JOHNSON
Other - Org Name:ELITE PROLAB MOBILE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:832-427-6743
Mailing Address - Street 1:16506 FM 529 RD STE 115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1463
Mailing Address - Country:US
Mailing Address - Phone:832-427-6743
Mailing Address - Fax:832-201-7383
Practice Address - Street 1:16506 FM 529 RD STE 115
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1463
Practice Address - Country:US
Practice Address - Phone:346-255-2192
Practice Address - Fax:832-201-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory