Provider Demographics
NPI:1255098257
Name:COVID-19 DIAGNOSTICS P INC
Entity type:Organization
Organization Name:COVID-19 DIAGNOSTICS P INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNIECE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-870-2581
Mailing Address - Street 1:11221 KATY FWY STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2105
Mailing Address - Country:US
Mailing Address - Phone:713-870-2581
Mailing Address - Fax:
Practice Address - Street 1:11221 KATY FWY STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2105
Practice Address - Country:US
Practice Address - Phone:832-641-9633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty