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General NPI Number Information
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NPI Number | 1245759141
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Entity Type | Organization
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Legal Business Name | LONG LIFE IMAGING, LLC
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 957 NASA PKWY # 1041
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City | HOUSTON
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State | TX
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Zip | 77058-3039
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Country | US
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Telephone | 346-261-2341
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Fax |
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Provider Business Mailing Address
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Address Line | 957 NASA PKWY # 1041
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City | HOUSTON
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State | TX
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Zip | 77058-3039
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Country | US
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Telephone | 346-261-2341
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MALLISSA LEE
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Credential | RDCS (AE), RVT (VT)
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Telephone | 281-865-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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