Healthcare Provider Details

I. General information

NPI: 1134631427
Provider Name (Legal Business Name): PALIWAL DIAGNOSTIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

40 WOLF RD UNIT 42
LEBANON NH
03766-1946
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-1933
  • Fax:
Mailing address:
  • Phone: 602-492-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AKSHAT PALIWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 602-492-1933