Provider Demographics
NPI:1073755419
Name:SOUTHWEST DIAGNOSTIC SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHWEST DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:PSGT, EMT-P
Authorized Official - Phone:760-562-7827
Mailing Address - Street 1:302 E 3RD ST
Mailing Address - Street 2:P.O. BOX 31-411
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2760
Mailing Address - Country:US
Mailing Address - Phone:760-460-4022
Mailing Address - Fax:760-460-4371
Practice Address - Street 1:420 HEFFERNAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4718
Practice Address - Country:US
Practice Address - Phone:760-460-4022
Practice Address - Fax:760-460-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic