MEDICARE: SECOND LIFE DIAGNOSTICS, INC

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	:	1780512228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND LIFE DIAGNOSTICS, INC

Provider Business Mailing Address
First Line	:	2710 REED RD STE 141
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-2498
Country	:	US
Telephone Number	:	504-957-7003
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 REED RD STE 141
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-2498
Country	:	US
Telephone Number	:	504-957-7003
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. GEORGY TETS
Credential	:	MD, PHD
Telephone Number	:	646-617-3088

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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