Healthcare Provider Details

I. General information

NPI: 1073797445
Provider Name (Legal Business Name): CARDIODIAGNOSTIC IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE 585W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST SUITE 585W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-9195
  • Fax: 310-360-9196
Mailing address:
  • Phone: 310-360-9195
  • Fax: 310-360-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA D KAY
Title or Position: OWNER
Credential:
Phone: 310-360-9195