Provider Demographics
NPI:1346335403
Name:CENTRAL DIAGNOSTIC IMAGING NETWORK
Entity Type:Organization
Organization Name:CENTRAL DIAGNOSTIC IMAGING NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-548-8333
Mailing Address - Street 1:1220 S CENTRAL AVE
Mailing Address - Street 2:#204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-548-8333
Mailing Address - Fax:818-548-7888
Practice Address - Street 1:1220 S CENTRAL AVE
Practice Address - Street 2:#204
Practice Address - City:GLANDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-548-8333
Practice Address - Fax:818-548-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG846872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATP094Medicare ID - Type Unspecified