Healthcare Provider Details

I. General information

NPI: 1871796888
Provider Name (Legal Business Name): PIONEER MEDICAL DIAGNOSTICS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S LOS ROBLES AVE
PASADENA CA
91106-3716
US

IV. Provider business mailing address

833 S LOS ROBLES AVE
PASADENA CA
91106-3716
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-5067
  • Fax:
Mailing address:
  • Phone: 310-592-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number704
License Number StateMA

VIII. Authorized Official

Name: KHASHAYAR POURMAND
Title or Position: CEO
Credential: RNCS.T
Phone: 310-592-5067