Healthcare Provider Details

I. General information

NPI: 1427578392
Provider Name (Legal Business Name): PMDTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 W CALDWELL AVE STE C
VISALIA CA
93277-9230
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 707-766-4140
  • Fax: 559-734-4383
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