Healthcare Provider Details

I. General information

NPI: 1558669093
Provider Name (Legal Business Name): ACCUSCAN DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14621 TITUS ST SUITE 131
VAN NUYS CA
91402-4905
US

IV. Provider business mailing address

14621 TITUS ST SUITE 131
VAN NUYS CA
91402-4905
US

V. Phone/Fax

Practice location:
  • Phone: 818-908-5925
  • Fax: 818-908-5925
Mailing address:
  • Phone: 818-908-5925
  • Fax: 818-908-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number002542091-0001-2
License Number StateCA

VIII. Authorized Official

Name: MRS. ZORAYDA GAUZON
Title or Position: OWNER
Credential:
Phone: 818-647-2103