Provider Demographics
NPI:1336972751
Name:PREVENTIVE HEALTH & WELLNESS DIAGNOSTICS
Entity type:Organization
Organization Name:PREVENTIVE HEALTH & WELLNESS DIAGNOSTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-410-5899
Mailing Address - Street 1:2065 DR HUGH EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-0066
Mailing Address - Country:US
Mailing Address - Phone:956-410-5899
Mailing Address - Fax:
Practice Address - Street 1:2065 DR HUGH EMERSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-0066
Practice Address - Country:US
Practice Address - Phone:956-410-5899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty