Provider Demographics
NPI:1457382400
Name:HEALTH DIAGNOSTICS OF CALIFORNIA LLC
Entity Type:Organization
Organization Name:HEALTH DIAGNOSTICS OF CALIFORNIA LLC
Other - Org Name:BMC DIAGNOSTICS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACKERIAN
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:510-865-9680
Practice Address - Street 1:625 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3705
Practice Address - Country:US
Practice Address - Phone:510-865-9670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH DIAGNOSTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-06
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42393261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16000ZMedicare PIN