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General NPI Number Information
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NPI Number | 1013218825
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Entity Type | Organization
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Legal Business Name | WOMEN'S DIAGNOSTIC IMAGING MED. CENTER, INC.
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 333 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2541
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Country | US
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Telephone | 626-405-8070
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Fax | 626-405-8804
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Provider Business Mailing Address
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Address Line | 333 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2541
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Country | US
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Telephone | 626-405-8070
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Fax | 626-405-8804
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Authorized Official
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Title or Position | CFO
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Name | UNA L MORRIS
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Credential | M.D.
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Telephone | 626-405-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | A29996
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License Number State | CA
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