Provider Demographics
NPI:1417492943
Name:POWERHOUSE DIAGNOSTICS
Entity Type:Organization
Organization Name:POWERHOUSE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-607-6391
Mailing Address - Street 1:713 SOUTH GORDON ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2863
Mailing Address - Country:US
Mailing Address - Phone:281-607-6391
Mailing Address - Fax:832-917-0660
Practice Address - Street 1:713 S GORDON ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-2863
Practice Address - Country:US
Practice Address - Phone:281-607-6391
Practice Address - Fax:832-917-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty