Healthcare Provider Details

I. General information

NPI: 1003963299
Provider Name (Legal Business Name): OSTEOPOROSIS DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 HARRIS ST SUITE F
EUREKA CA
95503-4866
US

IV. Provider business mailing address

2773 HARRIS ST SUITE F
EUREKA CA
95503-4866
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-1600
  • Fax: 707-445-3778
Mailing address:
  • Phone: 707-445-1600
  • Fax: 707-445-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License NumberC034152
License Number StateCA

VIII. Authorized Official

Name: GENA C PENNINGTON
Title or Position: PARTNER
Credential: M.D.
Phone: 707-445-1600