Provider Demographics
NPI:1134659709
Name:MISSION DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MISSION DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER CLIENT EXPERIENCE CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2801
Mailing Address - Street 1:2915 W BITTERS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2007
Mailing Address - Country:US
Mailing Address - Phone:210-598-4277
Mailing Address - Fax:
Practice Address - Street 1:2915 W BITTERS RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2007
Practice Address - Country:US
Practice Address - Phone:210-598-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty