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General NPI Number Information
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NPI Number | 1225462518
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Entity Type | Organization
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Legal Business Name | MAMMOSAFE, LLC
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 2100 WEST LOOP S STE 900
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City | HOUSTON
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State | TX
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Zip | 77027-3522
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Country | US
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Telephone | 713-590-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 WEST LOOP S STE 900
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City | HOUSTON
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State | TX
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Zip | 77027-3522
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Country | US
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Telephone | 713-590-3641
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. DANIEL RICHARD ROUBEIN
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Credential | M.D.
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Telephone | 713-256-0761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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