Provider Demographics
NPI:1447977145
Name:DIABETES MANAGEMENT CENTERS OF AMERICA, LLC
Entity type:Organization
Organization Name:DIABETES MANAGEMENT CENTERS OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NAWAB
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-640-8001
Mailing Address - Street 1:7080 SOUTHWEST FWY
Mailing Address - Street 2:STE 100A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2086
Mailing Address - Country:US
Mailing Address - Phone:713-774-7080
Mailing Address - Fax:713-774-0225
Practice Address - Street 1:7080 SOUTHWEST FWY STE 100A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2086
Practice Address - Country:US
Practice Address - Phone:713-774-7080
Practice Address - Fax:713-774-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty