Healthcare Provider Details

I. General information

NPI: 1760711360
Provider Name (Legal Business Name): SOUND DIAGNOSTIC IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 MUIRFIELD CT
PUEBLO CO
81001-1107
US

IV. Provider business mailing address

4105 MUIRFIELD CT
PUEBLO CO
81001-1107
US

V. Phone/Fax

Practice location:
  • Phone: 719-671-2877
  • Fax:
Mailing address:
  • Phone: 719-671-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number117271
License Number StateCO

VIII. Authorized Official

Name: MR. REZA ZIA-AHMADI
Title or Position: SONOGRAPHER
Credential: RDCS
Phone: 719-671-2877