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General NPI Number Information
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NPI Number | 1104443266
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Entity Type | Organization
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Legal Business Name | DE LABORATORY, LLC
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 2450 FONDREN RD STE 265
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City | HOUSTON
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State | TX
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Zip | 77063-2318
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Country | US
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Telephone | 562-534-5094
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 FONDREN RD STE 265
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City | HOUSTON
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State | TX
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Zip | 77063-2318
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Country | US
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Telephone | 281-942-7989
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CORINNA PORRAS
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Credential |
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Telephone | 281-942-7989
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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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