Provider Demographics
NPI:1639484801
Name:WEST PARK DIAGNOSTIC, INC
Entity Type:Organization
Organization Name:WEST PARK DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-493-3782
Mailing Address - Street 1:7457 HARWIN DR
Mailing Address - Street 2:155
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2018
Mailing Address - Country:US
Mailing Address - Phone:713-954-7100
Mailing Address - Fax:713-954-7106
Practice Address - Street 1:7457 HARWIN DR
Practice Address - Street 2:155
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2018
Practice Address - Country:US
Practice Address - Phone:713-954-7100
Practice Address - Fax:713-954-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty