Healthcare Provider Details

I. General information

NPI: 1568748838
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING AND DYNAMICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 W 9TH ST
SAN PEDRO CA
90731-3601
US

IV. Provider business mailing address

787 W 9TH ST
SAN PEDRO CA
90731-3601
US

V. Phone/Fax

Practice location:
  • Phone: 310-832-0258
  • Fax: 310-833-9832
Mailing address:
  • Phone: 310-832-0258
  • Fax: 310-833-9832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License NumberA
License Number StateCA

VIII. Authorized Official

Name: DR. PHILLIP EDWARD SCHOENWETTER
Title or Position: PRESIDENT
Credential: M. D.
Phone: 310-832-0258