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General NPI Number Information
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NPI Number | 1902493513
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Entity Type | Organization
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Legal Business Name | EVOLUTION LABORATORY SERVICES
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 7010 CHAMPIONS PLAZA DR STE 150C
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City | HOUSTON
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State | TX
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Zip | 77069-2396
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Country | US
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Telephone | 713-628-8587
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Fax | 281-786-2089
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Provider Business Mailing Address
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Address Line | 7010 CHAMPIONS PLAZA DR STE 150C
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City | HOUSTON
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State | TX
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Zip | 77069-2396
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Country | US
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Telephone | 713-628-8587
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Fax | 281-786-2089
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | BRYNN MARTINEZ
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Credential |
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Telephone | 832-434-8523
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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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