Organization
NORTHSIDE PATHOLOGY GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO CERVANTES-VAZQUEZ MD (PRESIDENT, MANAGER)
(281) 618-8515
Entity
Organization
Contact information
Practice address
510 W TIDWELL RD, PATHOLOGY / LABORATORY, HOUSTON, TX 77091-4339
(832) 443-9071
Mailing address
510 W TIDWELL RD, PATHOLOGY / LABORATORY, HOUSTON, TX 77091-4339
(832) 443-9071
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H7953
MEDICAL LICENSE
TX
Enumeration date
08/09/2010
Last updated
04/18/2020
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