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General NPI Number Information
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NPI Number | 1083903843
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Entity Type | Organization
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Legal Business Name | ROCKDALE BLACKHAWK LLC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 3692 E SAM HOUSTON PKWY S
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City | PASADENA
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State | TX
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Zip | 77505-3137
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Country | US
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Telephone | 512-450-4502
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Fax |
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Provider Business Mailing Address
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Address Line | 3692 E SAM HOUSTON PKWY S
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City | PASADENA
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State | TX
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Zip | 77505-3137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN OWENS
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Credential |
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Telephone | 512-445-4502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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