Provider Demographics
NPI:1639359771
Name:DOWNEY BREAST DIAGNOSTIC CLINIC INC
Entity type:Organization
Organization Name:DOWNEY BREAST DIAGNOSTIC CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-862-2778
Mailing Address - Street 1:8301 FLORENCE AVE
Mailing Address - Street 2:101
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3936
Mailing Address - Country:US
Mailing Address - Phone:562-862-2778
Mailing Address - Fax:562-862-7649
Practice Address - Street 1:8301 FLORENCE AVE
Practice Address - Street 2:101
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3936
Practice Address - Country:US
Practice Address - Phone:562-862-2778
Practice Address - Fax:562-862-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA372872471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0077220Medicaid
CA00A372871Medicaid
CAA37287OtherLICENCE NUMBER
CAA37287OtherLICENCE NUMBER