Organization
JBL ANESTHESIA MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN B LAU D.O. (PRESIDENT)
(818) 355-0376
Entity
Organization
Contact information
Practice address
323 S HELIOTROPE AVE, MONROVIA, CA 91016-2914
(818) 355-0376
Mailing address
PO BOX 5486, ORANGE, CA 92863-5486
(818) 550-0900
(818) 550-0900
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20A7545
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX75451
—
CA
01
—
ZZZ07284Z
BLUE SHIELD
CA
Enumeration date
02/11/2007
Last updated
06/23/2022
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