Healthcare Provider Details

I. General information

NPI: 1386872703
Provider Name (Legal Business Name): PACIFIC DIAGNOSTICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14450 TC JESTER SUITE #250
HOUSTON TX
77014-1332
US

IV. Provider business mailing address

P.O. BOX 132618
THE WOODLANDS TX
77393-2618
US

V. Phone/Fax

Practice location:
  • Phone: 713-774-7291
  • Fax: 713-774-5478
Mailing address:
  • Phone: 281-292-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberL1710
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAQIB A SIDDIQUI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-292-1121