Provider Demographics
NPI:1023275823
Name:DJ GLOBAL SOLUTIONS LLC
Entity type:Organization
Organization Name:DJ GLOBAL SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL ASSISTANT
Authorized Official - Phone:979-260-1024
Mailing Address - Street 1:4015 SOUTH TEXAS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4022
Mailing Address - Country:US
Mailing Address - Phone:979-220-3854
Mailing Address - Fax:979-260-1052
Practice Address - Street 1:4015 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4022
Practice Address - Country:US
Practice Address - Phone:979-220-3854
Practice Address - Fax:979-260-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1071963291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory