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General NPI Number Information
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NPI Number | 1710511522
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Entity Type | Organization
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Legal Business Name | IXI WELLNESS BELLAIRE LLC
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 5555 WEST LOOP S STE 340
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City | BELLAIRE
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State | TX
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Zip | 77401-2100
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Country | US
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Telephone | 855-239-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 5555 WEST LOOP S STE 340
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City | BELLAIRE
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State | TX
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Zip | 77401-2132
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Country | US
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Telephone | 713-485-6177
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | VIVIAN GARAKANI
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Credential |
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Telephone | 561-951-2160
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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 |
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License Number State |
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