Provider Demographics
NPI:1154084150
Name:TEXAS DIAGNOSTIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:TEXAS DIAGNOSTIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ONADIA
Authorized Official - Middle Name:CRISTOBALINA
Authorized Official - Last Name:CABRERA-MORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-494-2222
Mailing Address - Street 1:2508 WILLIAMS DR STE 270
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3263
Mailing Address - Country:US
Mailing Address - Phone:908-494-2222
Mailing Address - Fax:
Practice Address - Street 1:2508 WILLIAMS DR STE 270
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3263
Practice Address - Country:US
Practice Address - Phone:908-494-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty