Healthcare Provider Details

I. General information

NPI: 1962733923
Provider Name (Legal Business Name): DIAGNOSTIC CARE INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE 1170W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST SUITE 1170W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-3313
  • Fax: 310-691-8877
Mailing address:
  • Phone: 310-854-3313
  • Fax: 310-691-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberA72696
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA72696
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA72696
License Number StateCA

VIII. Authorized Official

Name: SHAHRIAR GHODSIAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-854-3313