Provider Demographics
NPI:1568748838
Name:DIAGNOSTIC IMAGING AND DYNAMICS, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING AND DYNAMICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SCHOENWETTER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:310-832-0258
Mailing Address - Street 1:787 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3601
Mailing Address - Country:US
Mailing Address - Phone:310-832-0258
Mailing Address - Fax:310-833-9832
Practice Address - Street 1:787 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3601
Practice Address - Country:US
Practice Address - Phone:310-832-0258
Practice Address - Fax:310-833-9832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700958667OtherNPI
CA1114241932OtherNPI