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General NPI Number Information
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NPI Number | 1235434887
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC CARE INC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 1012 S ROBERTSON BLVD STE E
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City | LOS ANGELES
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State | CA
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Zip | 90035-1551
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Country | US
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Telephone | 310-652-6537
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Fax | 310-943-1919
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Provider Business Mailing Address
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Address Line | 1012 S ROBERTSON BLVD STE E
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City | LOS ANGELES
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State | CA
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Zip | 90035-1551
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Country | US
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Telephone | 310-652-6537
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Fax | 310-943-1919
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SAM NICKBAKHT
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Credential |
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Telephone | 310-925-1145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 327249
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License Number State | CA
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