Healthcare Provider Details

I. General information

NPI: 1437869815
Provider Name (Legal Business Name): MEDVINCI DIAGNOSTICS OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N CENTRAL EXPY STE 500
DALLAS TX
75206-5249
US

IV. Provider business mailing address

6060 N CENTRAL EXPY STE 500
DALLAS TX
75206-5249
US

V. Phone/Fax

Practice location:
  • Phone: 832-647-0059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD VALENTINE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 832-647-0059