Healthcare Provider Details

I. General information

NPI: 1023415569
Provider Name (Legal Business Name): CAGE MOTION DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 MAGNOLIA AVE
CARLSBAD CA
92008-2540
US

IV. Provider business mailing address

PO BOX 580
LAKE CHARLES LA
70602-0580
US

V. Phone/Fax

Practice location:
  • Phone: 619-549-7142
  • Fax: 337-855-1829
Mailing address:
  • Phone: 337-855-9023
  • Fax: 337-855-1829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDY OSBORNE
Title or Position: MEMBER
Credential:
Phone: 619-549-7142