1609225325 NPI number — PRO ORACLE, LLC

Table of content: (NPI 1609225325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609225325 NPI number — PRO ORACLE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO ORACLE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609225325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10330 LAKE RD SUITE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-691-3427
Provider Business Mailing Address Fax Number:
832-941-1150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10330 LAKE RD SUITE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-691-3427
Provider Business Practice Location Address Fax Number:
832-941-1150
Provider Enumeration Date:
06/03/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NGO
Authorized Official First Name:
ANH
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER/FOUNDER
Authorized Official Telephone Number:
832-680-0119

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8GH327 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8GH327 . This is a "BCBS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".