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General NPI Number Information
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NPI Number | 1083920607
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA MEDICAL DIAGNOSTICS GROUP, INC.
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 1109 S CENTRAL AVE
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City | GLENDALE
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State | CA
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Zip | 91204-2212
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Country | US
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Telephone | 213-484-0004
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Fax | 213-484-0088
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Provider Business Mailing Address
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Address Line | PO BOX 10094
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City | GLENDALE
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State | CA
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Zip | 91209-3094
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Country | US
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Telephone | 818-244-4646
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Fax | 818-244-2047
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | SIM C HOFFMAN
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Credential | M.D.
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Telephone | 714-995-5400
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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 | G43636A
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | G43636A
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License Number State | CA
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