Provider Demographics
NPI:1619351566
Name:BIOPSY STAT
Entity Type:Organization
Organization Name:BIOPSY STAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-422-9416
Mailing Address - Street 1:2102 SHADOWBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6013
Mailing Address - Country:US
Mailing Address - Phone:214-422-9416
Mailing Address - Fax:832-962-8788
Practice Address - Street 1:3030 S GESSNER RD STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3765
Practice Address - Country:US
Practice Address - Phone:214-422-6416
Practice Address - Fax:832-962-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory