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General NPI Number Information
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NPI Number | 1922412584
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Entity Type | Organization
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Legal Business Name | KMA DIAGNOSTIC LLC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 10330 LAKE RD STE M
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City | HOUSTON
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State | TX
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Zip | 77070-1886
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Country | US
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Telephone | 713-960-4461
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 LAKE RD STE M
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City | HOUSTON
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State | TX
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Zip | 77070-1886
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Country | US
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Telephone | 713-960-4461
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MRS. ROSALIND W CIESLEWICZ
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Credential |
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Telephone | 713-960-4461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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