MEDICARE: WESTWATER DIAGNOSTICS PLLC

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	:	1417647819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTWATER DIAGNOSTICS PLLC

Provider Business Mailing Address
First Line	:	407 E 25TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-2305
Country	:	US
Telephone Number	:	713-559-6929
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 E 25TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-2305
Country	:	US
Telephone Number	:	713-559-6929
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZING OFFICIAL
Name	:	MHAIR DEKMEZIAN
Credential	:	MD
Telephone Number	:	713-559-6929

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	02/09/2026

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