Promus Diagnostics, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PROMUS DIAGNOSTICS, LLC

Practice address

525 S Kimball Ave
Southlake, TX 76092-8064

Phone

(817) 778-9210

Fax

(817) 778-9244

NPI assigned

Dec 7, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Victor Sansone III

Title

Owner

Phone

(817) 778-9210

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura Valencia

  • Behavior Technician
  • Pomona, CA
  • NPI 1003652249
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774483200000",
    "number": "1033680681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 S KIMBALL AVE",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928064",
            "telephone_number": "817-778-9210",
            "fax_number": "817-778-9244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 S KIMBALL AVE",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928064",
            "telephone_number": "817-778-9210",
            "fax_number": "817-778-9244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMUS DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-07",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A",
        "authorized_official_last_name": "SANSONE",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-778-9210",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Southlake, TX
• Providers in Southlake, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.