Provider Demographics
NPI:1730501693
Name:SELECTIVE DIAGNOSTICS INC
Entity Type:Organization
Organization Name:SELECTIVE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-850-2693
Mailing Address - Street 1:4695 MACARTHUR CT STE 430
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8854
Mailing Address - Country:US
Mailing Address - Phone:800-850-2693
Mailing Address - Fax:949-258-5626
Practice Address - Street 1:3432 WINDSPUN DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2011
Practice Address - Country:US
Practice Address - Phone:800-850-2693
Practice Address - Fax:949-258-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0596549208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty