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NPI Code Detail

MEDICARE: EZ-LAB-TEST

MEDICARE: EZ-LAB-TEST
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory45D2041509TX

General Provider Information

NPI Number : 1417219130
Entity Type Code : Organization
Provider Name (Legal Business Name) : EZ-LAB-TEST
Provider Business Mailing Address
First Line : 6633 HILLCROFT
Second Line : SUITE#261
City : HOUSTON
State : TX
Zip : 77081-4888
Country : US
Telephone Number : 281-975-8601
Fax Number : 713-370-2260
Provider Business Practice Location Address
First Line : 6633 HILLCROFT ST
Second Line : SUITE#261
City : HOUSTON
State : TX
Zip : 77081-4887
Country : US
Telephone Number : 281-975-8601
Fax Number : 713-370-2260
Authorized Official
Title or Position : OWNER
Name : MR. ALFREDO A GONZALES
Credential :
Telephone Number : 281-975-8601
Provider Enumeration Date : 06/08/2012
Last Update Date : 12/05/2012

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Directions to “EZ-LAB-TEST ” Practice Location

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