MEDICARE: GANTA DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1073476347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANTA DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	3505 S DAIRY ASHFORD RD STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5524
Country	:	US
Telephone Number	:	281-917-6270
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 S DAIRY ASHFORD RD STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5524
Country	:	US
Telephone Number	:	281-917-6270
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRASHANTH KUMAR GANTA
Credential	:
Telephone Number	:	281-917-6270

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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