Provider Demographics
NPI:1386872703
Name:PACIFIC DIAGNOSTICS, PA
Entity type:Organization
Organization Name:PACIFIC DIAGNOSTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAQIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-292-1121
Mailing Address - Street 1:P.O. BOX 132618
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-2618
Mailing Address - Country:US
Mailing Address - Phone:281-292-1121
Mailing Address - Fax:
Practice Address - Street 1:14450 TC JESTER
Practice Address - Street 2:SUITE #250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1332
Practice Address - Country:US
Practice Address - Phone:713-774-7291
Practice Address - Fax:713-774-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL17102081P2900X
2084N0600X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty