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General NPI Number Information
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NPI Number | 1679697387
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Entity Type | Organization
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Legal Business Name | ST MICHAELS LABS INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 3726 DACOMA ST
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City | HOUSTON
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State | TX
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Zip | 77092-8906
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Country | US
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Telephone | 713-812-1612
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 924587
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City | HOUSTON
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State | TX
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Zip | 77292-4587
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Country | US
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Telephone | 713-812-1612
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Fax |
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Authorized Official
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Title or Position | LABORATORY DIRECTOR
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Name | DR. RANDOLPH A LOPEZ
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Credential | M.D.,
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Telephone | 713-812-1612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D1044582
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License Number State | TX
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