MEDICARE: ONYX NEURODIAGNOSTIC, 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	204R00000X	Electrodiagnostic Medicine Physician

General Provider Information

NPI Number	:	1952793119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONYX NEURODIAGNOSTIC, LLC

Provider Business Mailing Address
First Line	:	2437 BAY AREA BLVD STE 461
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-1519
Country	:	US
Telephone Number	:	281-944-4701
Fax Number	:	888-789-4755

Provider Business Practice Location Address
First Line	:	2437 BAY AREA BLVD STE 461
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-1519
Country	:	US
Telephone Number	:	281-944-4701
Fax Number	:	888-789-4755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LOUIS CANO
Credential	:
Telephone Number	:	281-944-4701

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	04/12/2021

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