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General NPI Number Information
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NPI Number | 1003111352
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Entity Type | Organization
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Legal Business Name | GULF DIAGNOSTIC CENTER LLC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 1051 PINELOCH DR STE 700
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City | HOUSTON
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State | TX
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Zip | 77062-2738
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Country | US
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Telephone | 832-457-2167
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Fax | 281-715-4545
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Provider Business Mailing Address
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Address Line | PO BOX 1769
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City | CROSBY
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State | TX
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Zip | 77532-1769
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Country | US
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Telephone | 832-457-2167
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Fax | 281-715-4545
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Authorized Official
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Title or Position | CEO
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Name | DEVORA TORRENCE
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Credential |
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Telephone | 832-457-2167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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