Provider Demographics
NPI:1003413139
Name:WESTWATER DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:WESTWATER DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZING OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MHAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKMEZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-559-6929
Mailing Address - Street 1:3732 GLEN HAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1205
Mailing Address - Country:US
Mailing Address - Phone:713-559-6929
Mailing Address - Fax:713-559-6928
Practice Address - Street 1:3732 GLEN HAVEN BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1205
Practice Address - Country:US
Practice Address - Phone:713-559-6929
Practice Address - Fax:713-559-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty