Healthcare Provider Details

I. General information

NPI: 1184079923
Provider Name (Legal Business Name): COMPLETE DIAGNOSTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 FLORENCE AVE SUITE 5
BELL CA
90201-3801
US

IV. Provider business mailing address

5101 FLORENCE AVE SUITE 5
BELL CA
90201-3801
US

V. Phone/Fax

Practice location:
  • Phone: 562-407-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG30633
License Number StateCA

VIII. Authorized Official

Name: RICHARD MACKLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 562-407-2080