Healthcare Provider Details

I. General information

NPI: 1306835038
Provider Name (Legal Business Name): UNIVERSITY DIAGNOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27725 SANTA MARGARITA PARKWAY SUITE 101
MISSION VIEJO CA
92691-6706
US

IV. Provider business mailing address

27758 SANTA MARGARITA PARKWAY #409
MISSION VIEJO CA
92691-6709
US

V. Phone/Fax

Practice location:
  • Phone: 949-462-3999
  • Fax: 949-462-3777
Mailing address:
  • Phone: 949-364-5716
  • Fax: 949-364-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberA67310
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License NumberA67310
License Number StateCA

VIII. Authorized Official

Name: SEYED SHAHROKNI
Title or Position: OWNER/ MEDICAL DIRECTOR
Credential: M.D.
Phone: 949-462-3999