Provider Demographics
NPI:1407031941
Name:DIVERSIFIED INDEPENDENT DIAGNOSTICS INC
Entity Type:Organization
Organization Name:DIVERSIFIED INDEPENDENT DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-652-4050
Mailing Address - Street 1:1701 WEBSTER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-5849
Mailing Address - Country:US
Mailing Address - Phone:713-652-4050
Mailing Address - Fax:
Practice Address - Street 1:1701 WEBSTER ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-5849
Practice Address - Country:US
Practice Address - Phone:713-652-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty