Provider Demographics
NPI:1942478722
Name:CENTER FOR DIAGNOSTICS
Entity Type:Organization
Organization Name:CENTER FOR DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HERVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-293-0406
Mailing Address - Street 1:895 ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005
Mailing Address - Country:US
Mailing Address - Phone:702-293-0406
Mailing Address - Fax:702-293-0192
Practice Address - Street 1:895 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005
Practice Address - Country:US
Practice Address - Phone:702-293-0406
Practice Address - Fax:702-293-0192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY DOCTORS OF BOULDER CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0304053601247100000X
NV03540536022471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty