Healthcare Provider Details

I. General information

NPI: 1245427871
Provider Name (Legal Business Name): HI DIAGNOSTIC IMAGING GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W COLORADO ST STE 2
GLENDALE CA
91204-1670
US

IV. Provider business mailing address

318 W COLORADO ST STE 2
GLENDALE CA
91204-1670
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-5588
  • Fax: 818-242-3730
Mailing address:
  • Phone: 818-242-5588
  • Fax: 818-242-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberA46577
License Number StateCA

VIII. Authorized Official

Name: DR. MANSOUR TAFAZOLI
Title or Position: RADIOLOGIST
Credential: M.D.
Phone: 818-242-5588