1174932701 NPI number — HEALTH DIAGNOSTICS OF CALIFORNIA, LLC

Table of content: (NPI 1174932701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174932701 NPI number — HEALTH DIAGNOSTICS OF CALIFORNIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH DIAGNOSTICS OF CALIFORNIA, 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:
6
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:
1174932701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 203557
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-3557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-685-3909
Provider Business Mailing Address Fax Number:
800-508-4751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
665 MUNRAS AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-656-9800
Provider Business Practice Location Address Fax Number:
831-656-9801
Provider Enumeration Date:
08/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SIMON
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-264-2400

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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