Provider Demographics
NPI:1699001388
Name:PRESTIGE LABORATORY, LLC
Entity type:Organization
Organization Name:PRESTIGE LABORATORY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RASIKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DHEKNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-467-5414
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 2480
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-467-5414
Mailing Address - Fax:713-467-8557
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 2480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-467-5414
Practice Address - Fax:713-467-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory