Provider Demographics
NPI:1245488790
Name:LOVELIA LANE
Entity type:Organization
Organization Name:LOVELIA LANE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOVELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-267-4866
Mailing Address - Street 1:12821 MOUNTAIN AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4556
Mailing Address - Country:US
Mailing Address - Phone:909-267-4866
Mailing Address - Fax:
Practice Address - Street 1:12821 MOUNTAIN AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4556
Practice Address - Country:US
Practice Address - Phone:909-267-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D1087349291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP336Medicare PIN