Healthcare Provider Details

I. General information

NPI: 1114712825
Provider Name (Legal Business Name): ANISSA CANTREL RAINER LAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 11/13/2025
Certification Date: 10/27/2025
Deactivation Date: 10/27/2025
Reactivation Date: 11/13/2025

III. Provider practice location address

11970 WILCREST DR STE 102
HOUSTON TX
77031-1923
US

IV. Provider business mailing address

11970 WILCREST DR STE 102
HOUSTON TX
77031-1923
US

V. Phone/Fax

Practice location:
  • Phone: 346-735-4925
  • Fax:
Mailing address:
  • Phone: 346-735-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: