MEDICARE: LD HEALTHCARE SYSTEMS, CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	170300000X	Genetic Counselor (M.S.)
2	174400000X	Specialist
3	175F00000X	Naturopath
4	261QC1800X	Corporate Health Clinic/Center
5	261QG0250X	Genetics Clinic/Center
6	261QH0100X	Health Service Clinic/Center
7	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1417188095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LD HEALTHCARE SYSTEMS, CORP.

Provider Business Mailing Address
First Line	:	2100 TANNEHILL DR
Second Line	:	STE. 2093
City	:	HOUSTON
State	:	TX
Zip	:	77008-3125
Country	:	US
Telephone Number	:	832-641-5179
Fax Number	:

Provider Business Practice Location Address
First Line	:	5847 SAN FELIPE ST
Second Line	:	STE.1730
City	:	HOUSTON
State	:	TX
Zip	:	77057-3000
Country	:	US
Telephone Number	:	832-641-5179
Fax Number	:	530-420-4260

Authorized Official
Title or Position	:	VP/TREASURER
Name	:	MS. LUBA EUGENIA DIANGAR
Credential	:
Telephone Number	:	832-641-5179

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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