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General NPI Number Information
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NPI Number | 1225602451
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Entity Type | Organization
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Legal Business Name | DIAMOND DIAGNOSTIC CENTER
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 9535 FOREST LN STE 290
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City | DALLAS
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State | TX
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Zip | 75243-5900
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Country | US
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Telephone | 214-521-6058
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Fax | 214-614-8106
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Provider Business Mailing Address
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Address Line | 9535 FOREST LN STE 290
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City | DALLAS
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State | TX
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Zip | 75243-5900
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Country | US
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Telephone | 214-521-6058
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Fax | 214-614-8106
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Authorized Official
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Title or Position | CEO
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Name | MELBRA GARVEY
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Credential |
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Telephone | 832-620-8390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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