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General NPI Number Information
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NPI Number | 1912383225
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Entity Type | Organization
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Legal Business Name | TEXANS TOXICOLOGY LABORATORY, LLC
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 25319 INTERSTATE 45 SUITE 101
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City | SPRING
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State | TX
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Zip | 77380-3549
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Country | US
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Telephone | 936-242-0376
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Fax | 936-242-0377
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Provider Business Mailing Address
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Address Line | 25319 INTERSTATE 45 SUITE 101
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City | SPRING
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State | TX
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Zip | 77380-3549
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Country | US
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Telephone | 936-242-0376
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Fax | 936-242-0377
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | DR. TEODULO E. AVES
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Credential | M.D.
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Telephone | 713-863-7246
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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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