Provider Demographics
NPI:1013218825
Name:WOMEN'S DIAGNOSTIC IMAGING MED. CENTER, INC.
Entity Type:Organization
Organization Name:WOMEN'S DIAGNOSTIC IMAGING MED. CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:UNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-405-8070
Mailing Address - Street 1:333 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2541
Mailing Address - Country:US
Mailing Address - Phone:626-405-8070
Mailing Address - Fax:626-405-8804
Practice Address - Street 1:333 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2541
Practice Address - Country:US
Practice Address - Phone:626-405-8070
Practice Address - Fax:626-405-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA299962471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A299960Medicaid
CA00A299960Medicaid