MEDICARE: ORIGIN 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1497638894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORIGIN DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	9135 KATY FWY STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1636
Country	:	US
Telephone Number	:	832-429-2216
Fax Number	:

Provider Business Practice Location Address
First Line	:	19610 TOMBALL PKWY STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-6170
Country	:	US
Telephone Number	:	281-899-0019
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALI MAZLOOM
Credential	:
Telephone Number	:	832-429-2216

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	08/08/2025

Similar Medicare Providers

1073362331 — DANIEL MAX & MARC ANDREA LLC
Practice Location Address:

19610 TOMBALL PKWY STE 100
HOUSTON, TX
77070-6170

Practice Phone: 346-353-7440
Practice Fax: 346-353-7441

1942057781 — ABAYA WELLNESS & HOME HEALTHCARE, LLC
Practice Location Address:

4899 MONTROSE BLVD APT 1509
HOUSTON, TX
77006-6170

Practice Phone: 832-847-5273
Practice Fax:

1396696027 — CELESTE MARLENE SIMMONS RN
Practice Location Address:

14035 CLEOBROOK DR
HOUSTON, TX
77070-3714

Practice Phone: 775-336-8420
Practice Fax:

1831685635 — MRS. NISHEA ANDREA FLORES APRN, FNP-C
Practice Location Address:

20405 STATE HIGHWAY 249 STE 325
HOUSTON, TX
77070-2893

Practice Phone: 866-849-0692
Practice Fax: 888-973-8821

1932458908 — LEESA ANN BROWN APRN, ANP-C
Practice Location Address:

20405 STATE HIGHWAY 249 STE 325
HOUSTON, TX
77070-2893

Practice Phone: 866-849-0692
Practice Fax:

1649970880 — AUDREY CAMILLE CAO
Practice Location Address:

22545 TX 249 , SUITE 130
HOUSTON, TX
77070

Practice Phone: 281-779-4220
Practice Fax:

Directions to “ORIGIN DIAGNOSTICS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.