Provider Demographics
NPI:1477781748
Name:DBACK 5
Entity Type:Organization
Organization Name:DBACK 5
Other - Org Name:PRESTIGE LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:956-782-6200
Mailing Address - Street 1:409 W FM 495
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3717
Mailing Address - Country:US
Mailing Address - Phone:956-782-6200
Mailing Address - Fax:956-782-6202
Practice Address - Street 1:5503 MORTON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1338
Practice Address - Country:US
Practice Address - Phone:956-782-6200
Practice Address - Fax:956-782-6202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE LABORATORY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory