Healthcare Provider Details

I. General information

NPI: 1164885992
Provider Name (Legal Business Name): PMDTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29122 RANCHO VIEJO RD STE 208
SAN JUAN CAPISTRANO CA
92675-1039
US

IV. Provider business mailing address

1600 W BROADWAY RD STE 155
TEMPE AZ
85282-1138
US

V. Phone/Fax

Practice location:
  • Phone: 949-550-2279
  • Fax:
Mailing address:
  • Phone: 480-528-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateCA

VIII. Authorized Official

Name: TANGINA MALOOF
Title or Position: TREASURER
Credential:
Phone: 469-636-5055