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General NPI Number Information
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NPI Number | 1558636191
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Entity Type | Organization
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Legal Business Name | HOLISTICA, LLC
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 1980 POST OAK BLVD STE 1500 1980 POST OAK BLVD, STE 1500
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City | HOUSTON
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State | TX
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Zip | 77056-3845
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Country | US
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Telephone | 713-840-0384
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Fax | 281-254-7911
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Provider Business Mailing Address
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Address Line | 1980 POST OAK BLVD STE 1500 TWO POST OAK CENTRAL
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City | HOUSTON
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State | TX
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Zip | 77056-3845
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Country | US
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Telephone | 713-840-0384
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Fax | 281-254-7911
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Authorized Official
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Title or Position | CEO
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Name | MR. XAVIER E SANDOVAL
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Credential |
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Telephone | 713-840-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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