Provider Demographics
NPI:1104867803
Name:HORNBUCKLE, INC.
Entity Type:Organization
Organization Name:HORNBUCKLE, INC.
Other - Org Name:CALIFORNIA COMMUNITY DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HORNBUCKLE
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:310-558-1530
Mailing Address - Street 1:1009 ABBOT KINNEY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3372
Mailing Address - Country:US
Mailing Address - Phone:310-558-1530
Mailing Address - Fax:310-526-7775
Practice Address - Street 1:1009 ABBOT KINNEY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3372
Practice Address - Country:US
Practice Address - Phone:310-558-1530
Practice Address - Fax:310-526-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty