Healthcare Provider Details

I. General information

NPI: 1902557085
Provider Name (Legal Business Name): RGM DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 MERWIN ST
HOUSTON TX
77027-6607
US

IV. Provider business mailing address

4715 MERWIN ST
HOUSTON TX
77027-6607
US

V. Phone/Fax

Practice location:
  • Phone: 323-762-3742
  • Fax:
Mailing address:
  • Phone: 323-762-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ROBERT VELARDE
Title or Position: OWNER
Credential: MD
Phone: 323-762-3742