Provider Demographics
NPI:1306835038
Name:UNIVERSITY DIAGNOTICS, INC.
Entity Type:Organization
Organization Name:UNIVERSITY DIAGNOTICS, INC.
Other - Org Name:ORANGE COUNTY DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHROKNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-462-3999
Mailing Address - Street 1:27758 SANTA MARGARITA PARKWAY
Mailing Address - Street 2:#409
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6709
Mailing Address - Country:US
Mailing Address - Phone:949-364-5716
Mailing Address - Fax:949-364-5777
Practice Address - Street 1:27725 SANTA MARGARITA PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6706
Practice Address - Country:US
Practice Address - Phone:949-462-3999
Practice Address - Fax:949-462-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-15
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0200X, 261QR0206X
CAA67310261QR0200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA237923OtherMAMMOGRAPHY CERT NUM
CAGR0098650Medicaid
CADD6379OtherRAILROAD MEDICARE
CAZZZ66771ZOtherBLUE SHIELD OF CA
CAW18014Medicare PIN
CA237923OtherMAMMOGRAPHY CERT NUM
CADD6379OtherRAILROAD MEDICARE
CAGR0098650Medicaid