Provider Demographics
NPI:1003042235
Name:HEALTH DIAGNOSTICS OF CALIFORNIA LLC
Entity type:Organization
Organization Name:HEALTH DIAGNOSTICS OF CALIFORNIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-264-2400
Mailing Address - Street 1:PO BOX 203557
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-3557
Mailing Address - Country:US
Mailing Address - Phone:888-685-3910
Mailing Address - Fax:800-508-4751
Practice Address - Street 1:8370 WILSHIRE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2333
Practice Address - Country:US
Practice Address - Phone:323-966-0000
Practice Address - Fax:323-966-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO492AMedicare PIN