Provider Demographics
NPI:1407200546
Name:SOCAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SOCAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:AARON WALTER
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-999-5679
Mailing Address - Street 1:1500 S ANAHEIM BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6242
Mailing Address - Country:US
Mailing Address - Phone:657-999-5679
Mailing Address - Fax:
Practice Address - Street 1:1500 S ANAHEIM BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6242
Practice Address - Country:US
Practice Address - Phone:657-999-5679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty