Provider Demographics
NPI:1790215358
Name:DIABETES REVERSAL OF AMERICA, LLC
Entity Type:Organization
Organization Name:DIABETES REVERSAL OF AMERICA, LLC
Other - Org Name:MEDICAL BIODIAGNOSTIC LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-808-7381
Mailing Address - Street 1:5723 STAR LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7113
Mailing Address - Country:US
Mailing Address - Phone:281-808-7381
Mailing Address - Fax:281-861-8415
Practice Address - Street 1:1463 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-4568
Practice Address - Country:US
Practice Address - Phone:281-808-7381
Practice Address - Fax:281-624-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy