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General NPI Number Information
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NPI Number | 1073054417
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Entity Type | Organization
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Legal Business Name | LOUSTED AUSTIN
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 3404 MONTE VISTA DR
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City | AUSTIN
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State | TX
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Zip | 78731-5723
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Country | US
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Telephone | 512-715-4824
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Fax |
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Provider Business Mailing Address
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Address Line | 3404 MONTE VISTA DR
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City | AUSTIN
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State | TX
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Zip | 78731-5723
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Country | US
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Telephone | 512-715-4824
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MICHELLE SUNSHINE
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Credential |
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Telephone | 512-465-1998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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