Provider Demographics
NPI:1285845099
Name:DIABETES CENTERS OF AMERICA
Entity Type:Organization
Organization Name:DIABETES CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RZENDZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-237-3500
Mailing Address - Street 1:11321 FALLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4232
Mailing Address - Country:US
Mailing Address - Phone:832-237-3500
Mailing Address - Fax:832-237-0200
Practice Address - Street 1:2020 NASA PARKWAY MEDICAL BUILDING
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:832-237-3500
Practice Address - Fax:832-237-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00593X261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00593XMedicare ID - Type UnspecifiedMEDICARE LICENSE