Organization
SOUTHEAST DIAGNOSTIC CONSULTANTS, LLC
Active
Other names
Southeast Neurology, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANNA LAROQUE (DIRECTOR, CLIENT EXPERIENCE)
(210) 598-4277
Entity
Organization
Contact information
Practice address
2000 S BAYSHORE DR APT 56, MIAMI, FL 33133-3252
(210) 598-4277
Mailing address
1141 N LOOP 1604 E # 105-612, SAN ANTONIO, TX 78232-1339
(210) 598-4277
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
12/27/2022
Last updated
12/27/2022
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