Provider Demographics
NPI:1841203643
Name:OAK TREE DIAGNOSTIC, LLC
Entity Type:Organization
Organization Name:OAK TREE DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-245-9797
Mailing Address - Street 1:720 AVENUE F N
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-9573
Mailing Address - Country:US
Mailing Address - Phone:979-245-9797
Mailing Address - Fax:979-245-9789
Practice Address - Street 1:720 AVENUE F N
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-9573
Practice Address - Country:US
Practice Address - Phone:979-245-9797
Practice Address - Fax:979-245-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)