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General NPI Number Information
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NPI Number | 1073814448
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED DIAGNOSTICS
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 2225 W SOUTHLAKE BLVD SUITE 124
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6750
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Country | US
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Telephone | 817-879-0962
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Fax | 800-343-8718
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Provider Business Mailing Address
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Address Line | 2225 W SOUTHLAKE BLVD SUITE 124
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6750
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Country | US
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Telephone | 817-879-0962
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Fax | 800-343-8718
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TINA M YORK
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Credential |
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Telephone | 817-879-0962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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