Provider Demographics
NPI:1326138603
Name:OSTEOPOROSIS DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:OSTEOPOROSIS DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-786-5595
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-1206
Mailing Address - Country:US
Mailing Address - Phone:916-989-9044
Mailing Address - Fax:916-988-5288
Practice Address - Street 1:151 N SUNRISE AVE
Practice Address - Street 2:STE 901
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2924
Practice Address - Country:US
Practice Address - Phone:916-786-5595
Practice Address - Fax:916-786-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0527922471B0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20760ZMedicare ID - Type Unspecified