Healthcare Provider Details

I. General information

NPI: 1710626833
Provider Name (Legal Business Name): LIFE PULSE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 RICHMOND AVE STE 405
HOUSTON TX
77057-6171
US

IV. Provider business mailing address

6420 RICHMOND AVE STE 405
HOUSTON TX
77057-6171
US

V. Phone/Fax

Practice location:
  • Phone: 713-691-7744
  • Fax: 713-691-6665
Mailing address:
  • Phone: 713-691-7744
  • Fax: 713-691-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GLORIA BROUSSARD
Title or Position: OWNER
Credential:
Phone: 713-691-7744