Organization
LBJ LABORATORY SUPPORT SERVICES CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA ELIA MONTELONGO (CEO)
(713) 303-9415
Entity
Organization
Contact information
Practice address
2626 SOUTH LOOP WEST SUITE 240, HOUSTON, TX 77054
(713) 592-0343
(713) 592-0357
Mailing address
2626 SOUTH LOOP WEST SUITE 240, HOUSTON, TX 77054
(713) 303-9415
(713) 665-8349
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
649296
TX
246RP1900X
Phlebotomy Technician
Primary
20.0075R05
DC
291U00000X
Clinical Medical Laboratory
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Other
Enumeration date
09/17/2008
Last updated
09/17/2008
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