Provider Demographics
NPI:1609211150
Name:TESSLA DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:TESSLA DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-576-6903
Mailing Address - Street 1:PO BOX 9359
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-9359
Mailing Address - Country:US
Mailing Address - Phone:713-576-6903
Mailing Address - Fax:
Practice Address - Street 1:22820 I-45
Practice Address - Street 2:BLDG 4-C
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-0000
Practice Address - Country:US
Practice Address - Phone:713-576-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty