Healthcare Provider Details

I. General information

NPI: 1922412584
Provider Name (Legal Business Name): KMA DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 LAKE RD STE M
HOUSTON TX
77070-1886
US

IV. Provider business mailing address

10330 LAKE RD STE M
HOUSTON TX
77070-1886
US

V. Phone/Fax

Practice location:
  • Phone: 713-960-4461
  • Fax:
Mailing address:
  • Phone: 713-960-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSALIND W CIESLEWICZ
Title or Position: PRESIDENT / CEO
Credential:
Phone: 713-960-4461