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NPI Code Detail

MEDICARE: LIFE PULSE DIAGNOSTICS LLC

MEDICARE: LIFE PULSE 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
1246ZE0500XEEG Specialist/Technologist
22472E0500XEEG Technician
3208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1710626833
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE PULSE DIAGNOSTICS LLC
Provider Business Mailing Address
First Line : 6420 RICHMOND AVE STE 405
Second Line :
City : HOUSTON
State : TX
Zip : 77057-6171
Country : US
Telephone Number : 713-691-7744
Fax Number : 713-691-6665
Provider Business Practice Location Address
First Line : 6420 RICHMOND AVE STE 405
Second Line :
City : HOUSTON
State : TX
Zip : 77057-6171
Country : US
Telephone Number : 713-691-7744
Fax Number : 713-691-6665
Authorized Official
Title or Position : OWNER
Name : GLORIA BROUSSARD
Credential :
Telephone Number : 713-691-7744
Provider Enumeration Date : 05/27/2022
Last Update Date : 03/09/2023

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Directions to “LIFE PULSE DIAGNOSTICS LLC ” Practice Location

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