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General NPI Number Information
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NPI Number | 1518419068
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Entity Type | Organization
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Legal Business Name | PMDTC, LLC
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 29122 RANCHO VIEJO RD STE 208
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1039
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Country | US
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Telephone | 949-550-2279
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 W BROADWAY RD STE 155
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City | TEMPE
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State | AZ
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Zip | 85282-1138
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Country | US
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Telephone | 480-528-3322
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | TANGINA R MALOOF
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Credential |
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Telephone | 469-636-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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