Healthcare Provider Details

I. General information

NPI: 1407447733
Provider Name (Legal Business Name): LAXA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16959 SOUTHWEST FWY STE 200
SUGAR LAND TX
77479-3481
US

IV. Provider business mailing address

5323 BEVERLYHILL ST APT 27
HOUSTON TX
77056-6953
US

V. Phone/Fax

Practice location:
  • Phone: 281-603-4655
  • Fax: 936-570-1181
Mailing address:
  • Phone: 281-603-4041
  • Fax: 936-570-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MURIEL DOYLE
Title or Position: PRESIDENT
Credential: RD/LD, CDCES
Phone: 281-603-4041