Healthcare Provider Details

I. General information

NPI: 1548173347
Provider Name (Legal Business Name): ULTIMATE DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 KING ARTHURS CT APT 32
LAREDO TX
78041-2973
US

IV. Provider business mailing address

7613 KING ARTHURS CT APT 32
LAREDO TX
78041-2973
US

V. Phone/Fax

Practice location:
  • Phone: 956-469-0355
  • Fax:
Mailing address:
  • Phone: 956-469-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN JESUS GONZALEZ JR.
Title or Position: OWNER
Credential:
Phone: 956-393-7531