Healthcare Provider Details

I. General information

NPI: 1699706648
Provider Name (Legal Business Name): HEALTH DIAGNOSTICS OF CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 REDWOOD HWY SUITE B
SAN RAFAEL CA
94903-2646
US

IV. Provider business mailing address

PO BOX 5651
ORANGE CA
92863-5651
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-9907
  • Fax: 415-479-9908
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number040095
License Number StateCA

VIII. Authorized Official

Name: HOWARD J. SIMON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-264-2400