Provider Demographics
NPI:1710511522
Name:IXI WELLNESS BELLAIRE LLC
Entity Type:Organization
Organization Name:IXI WELLNESS BELLAIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARAKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-951-2160
Mailing Address - Street 1:5555 WEST LOOP S STE 340
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2132
Mailing Address - Country:US
Mailing Address - Phone:713-485-6177
Mailing Address - Fax:
Practice Address - Street 1:5555 WEST LOOP S STE 340
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2100
Practice Address - Country:US
Practice Address - Phone:855-239-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory