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General NPI Number Information
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NPI Number | 1730501693
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Entity Type | Organization
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Legal Business Name | SELECTIVE DIAGNOSTICS INC
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 3432 WINDSPUN DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2011
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Country | US
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Telephone | 800-850-2693
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Fax | 949-258-5626
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Provider Business Mailing Address
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Address Line | 4695 MACARTHUR CT STE 430
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-8854
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Country | US
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Telephone | 800-850-2693
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Fax | 949-258-5626
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD SCHILLING
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Credential | MD
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Telephone | 800-850-2693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A0596549
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License Number State | CA
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