Provider Demographics
NPI:1154601748
Name:IND OPULENCE LLC
Entity type:Organization
Organization Name:IND OPULENCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SESHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:210-267-5501
Mailing Address - Street 1:17700 N US HIGHWAY 281
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1404
Mailing Address - Country:US
Mailing Address - Phone:210-267-5501
Mailing Address - Fax:210-267-5502
Practice Address - Street 1:17700 N US HIGHWAY 281
Practice Address - Street 2:SUITE # 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1404
Practice Address - Country:US
Practice Address - Phone:210-267-5501
Practice Address - Fax:210-267-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2004615291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory