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General NPI Number Information
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NPI Number | 1003963299
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Entity Type | Organization
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Legal Business Name | OSTEOPOROSIS DIAGNOSTIC CENTER
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2773 HARRIS ST SUITE F
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City | EUREKA
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State | CA
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Zip | 95503-4866
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Country | US
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Telephone | 707-445-1600
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Fax | 707-445-3778
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Provider Business Mailing Address
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Address Line | 2773 HARRIS ST SUITE F
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City | EUREKA
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State | CA
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Zip | 95503-4866
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Country | US
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Telephone | 707-445-1600
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Fax | 707-445-3778
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Authorized Official
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Title or Position | PARTNER
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Name | GENA C PENNINGTON
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Credential | M.D.
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Telephone | 707-445-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471B0102X
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Taxonomy Name | Bone Densitometry Radiologic Technologist
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License Number | C034152
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License Number State | CA
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