Provider Demographics
NPI:1710626833
Name:LIFE PULSE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:LIFE PULSE DIAGNOSTICS LLC
Other - Org Name:LIFE PULSE DIAGNOSTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-691-7744
Mailing Address - Street 1:6420 RICHMOND AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6171
Mailing Address - Country:US
Mailing Address - Phone:713-691-7744
Mailing Address - Fax:713-691-6665
Practice Address - Street 1:6420 RICHMOND AVE STE 405
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6171
Practice Address - Country:US
Practice Address - Phone:713-691-7744
Practice Address - Fax:713-691-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Multi-Specialty
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty