Provider Demographics
NPI:1962855734
Name:BIOCENTRA DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:BIOCENTRA DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-553-9056
Mailing Address - Street 1:3000 JOE DIMAGGIO BLVD STE 77
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3997
Mailing Address - Country:US
Mailing Address - Phone:512-553-9056
Mailing Address - Fax:
Practice Address - Street 1:3000 JOE DIMAGGIO BLVD STE 77
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3997
Practice Address - Country:US
Practice Address - Phone:512-553-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory