Provider Demographics
NPI:1225427909
Name:KINECKTION DIAGNOSTIC
Entity Type:Organization
Organization Name:KINECKTION DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-602-0262
Mailing Address - Street 1:5670 EL CAMINO REAL
Mailing Address - Street 2:SUITE F
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7125
Mailing Address - Country:US
Mailing Address - Phone:760-602-0262
Mailing Address - Fax:760-602-0150
Practice Address - Street 1:5670 EL CAMINO REAL
Practice Address - Street 2:SUITE F
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7125
Practice Address - Country:US
Practice Address - Phone:760-602-0262
Practice Address - Fax:760-602-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-18
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246ZE0600X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty