Provider Demographics
NPI:1467764597
Name:HEALTH DIAGNOSTICS OF DALY CITY, LLC
Entity Type:Organization
Organization Name:HEALTH DIAGNOSTICS OF DALY CITY, LLC
Other - Org Name:HEALTH DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-865-9670
Mailing Address - Street 1:1201 MARINA VILLAGE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1087
Mailing Address - Country:US
Mailing Address - Phone:510-865-9670
Mailing Address - Fax:510-217-9708
Practice Address - Street 1:455 HICKEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2629
Practice Address - Country:US
Practice Address - Phone:650-757-2030
Practice Address - Fax:650-757-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology