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General NPI Number Information
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NPI Number | 1417561358
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Entity Type | Organization
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Legal Business Name | BNB DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 350 NURSERY RD STE 3102
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City | SPRING
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State | TX
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Zip | 77380-4079
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Country | US
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Telephone | 346-351-1203
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Fax |
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Provider Business Mailing Address
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Address Line | 350 NURSERY RD STE 3102
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City | SPRING
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State | TX
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Zip | 77380-4079
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Country | US
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Telephone | 346-351-1203
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | BRENNEN LARK
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Credential |
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Telephone | 504-494-3543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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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 | 207RI0001X
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Taxonomy Name | Clinical & Laboratory Immunology (Internal Medicine) Physician
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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 | 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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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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