Healthcare Provider Details

I. General information

NPI: 1104730258
Provider Name (Legal Business Name): PROHEALTH DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15550 KINGFIELD DR APT 1204
HOUSTON TX
77084-6269
US

IV. Provider business mailing address

5900 BALCONES DR
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 22-321-4693
  • Fax:
Mailing address:
  • Phone: 22-321-4693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL ANGELOS
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 223-214-6936