Provider Demographics
NPI:1275204919
Name:BIOCENTRA LLC
Entity Type:Organization
Organization Name:BIOCENTRA LLC
Other - Org Name:BIOCENTRA DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-300-3050
Mailing Address - Street 1:5600 S WILLOW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-4721
Mailing Address - Country:US
Mailing Address - Phone:713-300-3050
Mailing Address - Fax:281-377-4445
Practice Address - Street 1:5600 S WILLOW DR STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-4721
Practice Address - Country:US
Practice Address - Phone:281-301-5892
Practice Address - Fax:281-377-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory