Organization
DIAGNOSTIC VIROLOGY LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONJA BEATY (EXECUTIVE DIRECTOR)
(713) 798-1127
Entity
Organization
Contact information
Practice address
6621 FANNIN ST, HOUSTON, TX 77030-2303
(832) 824-2280
(832) 825-2282
Mailing address
6621 FANNIN ST, HOUSTON, TX 77030-2303
(832) 824-2280
(832) 825-2282
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
B22211
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL5067
BC/BS
TX
Enumeration date
02/15/2008
Last updated
02/15/2008
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