Healthcare Provider Details

I. General information

NPI: 1942478722
Provider Name (Legal Business Name): CENTER FOR DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 ADAMS BLVD
BOULDER CITY NV
89005
US

IV. Provider business mailing address

895 ADAMS BLVD
BOULDER CITY NV
89005
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-0406
  • Fax: 702-293-0192
Mailing address:
  • Phone: 702-293-0406
  • Fax: 702-293-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number0304053601
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number0354053602
License Number StateNV

VIII. Authorized Official

Name: HERVE BEZARD
Title or Position: MD
Credential: MD
Phone: 702-293-0406