Healthcare Provider Details

I. General information

NPI: 1376902015
Provider Name (Legal Business Name): SOCAL DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 VAL VERDE DR
WEST HILLS CA
91304-2135
US

IV. Provider business mailing address

8500 VAL VERDE DR
WEST HILLS CA
91304-2135
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-5154
  • Fax:
Mailing address:
  • Phone: 310-795-5154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN YAKER
Title or Position: OWNER
Credential:
Phone: 310-795-5154