Provider Demographics
NPI:1336605419
Name:DIVERSE COMMUNITY URGENT CARE PLLC
Entity Type:Organization
Organization Name:DIVERSE COMMUNITY URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-354-2417
Mailing Address - Street 1:21898 FM 1314 RD STE B
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-7061
Mailing Address - Country:US
Mailing Address - Phone:281-354-2417
Mailing Address - Fax:281-786-0267
Practice Address - Street 1:21898 FM 1314 RD STE B
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-7061
Practice Address - Country:US
Practice Address - Phone:281-354-2417
Practice Address - Fax:281-786-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care