Healthcare Provider Details

I. General information

NPI: 1497988182
Provider Name (Legal Business Name): OAKRIDGE DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26222 I H 45 SUITE A
SPRING TX
77386-1024
US

IV. Provider business mailing address

705 E HOUSTON ST
CLEVELAND TX
77327-4630
US

V. Phone/Fax

Practice location:
  • Phone: 281-292-1310
  • Fax: 281-292-1825
Mailing address:
  • Phone: 281-592-1115
  • Fax: 281-592-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberJ4767
License Number StateTX

VIII. Authorized Official

Name: DR. RAFAEL DELAFLOR WEISS
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 281-592-1115