Provider Demographics
NPI:1245427871
Name:HI DIAGNOSTIC IMAGING GROUP, INC
Entity Type:Organization
Organization Name:HI DIAGNOSTIC IMAGING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFAZOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-242-5588
Mailing Address - Street 1:318 W COLORADO ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1670
Mailing Address - Country:US
Mailing Address - Phone:818-242-5588
Mailing Address - Fax:818-242-3730
Practice Address - Street 1:318 W COLORADO ST STE 2
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1670
Practice Address - Country:US
Practice Address - Phone:818-242-5588
Practice Address - Fax:818-242-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46577261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology