Provider Demographics
NPI:1104454651
Name:ALAINE DIAGNOSTIC LLC
Entity type:Organization
Organization Name:ALAINE DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MINI
Authorized Official - Middle Name:
Authorized Official - Last Name:VETTICADAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-746-9758
Mailing Address - Street 1:3505 SAGE RD UNIT 2504
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-7183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9000 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1529
Practice Address - Country:US
Practice Address - Phone:832-746-9758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Yes291U00000XLaboratoriesClinical Medical Laboratory