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General NPI Number Information
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NPI Number | 1073755419
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DIAGNOSTIC SERVICES, LLC
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 420 HEFFERNAN AVE SUITE D
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City | CALEXICO
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State | CA
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Zip | 92231-4718
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Country | US
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Telephone | 760-460-4022
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Fax | 760-460-4371
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Provider Business Mailing Address
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Address Line | 302 E 3RD ST P.O. BOX 31-411
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City | CALEXICO
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State | CA
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Zip | 92231-2760
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Country | US
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Telephone | 760-460-4022
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Fax | 760-460-4371
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Authorized Official
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Title or Position | MANAGER
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Name | IVAN ARMANDO MENDOZA
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Credential | PSGT, EMT-P
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Telephone | 760-562-7827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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