Provider Demographics
NPI:1144389230
Name:PERINATAL DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:PERINATAL DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYOUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:JADALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-777-7406
Mailing Address - Street 1:PO BOX 7448
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7448
Mailing Address - Country:US
Mailing Address - Phone:805-643-9781
Mailing Address - Fax:
Practice Address - Street 1:2100 LYNN RD STE 125
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8032
Practice Address - Country:US
Practice Address - Phone:805-777-7406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48921207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1908651OtherMEDIAL LIC
NY25MA06354400OtherMEDICAL LIC
CA00A48921Medicaid
NY25MA06354400OtherMEDICAL LIC