Provider Demographics
NPI:1417219130
Name:EZ-LAB-TEST
Entity Type:Organization
Organization Name:EZ-LAB-TEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-975-8601
Mailing Address - Street 1:6633 HILLCROFT
Mailing Address - Street 2:SUITE#261
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4888
Mailing Address - Country:US
Mailing Address - Phone:281-975-8601
Mailing Address - Fax:713-370-2260
Practice Address - Street 1:6633 HILLCROFT ST
Practice Address - Street 2:SUITE#261
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4887
Practice Address - Country:US
Practice Address - Phone:281-975-8601
Practice Address - Fax:713-370-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2041509291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory