MEDICARE: PROXIMA DIAGNOSTICS & LABORATORY 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	:	1932063237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROXIMA DIAGNOSTICS & LABORATORY LLC

Provider Business Mailing Address
First Line	:	3707 WESTCENTER DR STE 273
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-5295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 WESTCENTER DR STE 273
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-5295
Country	:	US
Telephone Number	:	832-951-4147
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	BALAJI GAJULA
Credential	:
Telephone Number	:	832-951-4147

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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