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General NPI Number Information
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NPI Number | 1760706576
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Entity Type | Organization
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Legal Business Name | SDXRAY & LAB
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 3220 S BREA CANYON RD STE B
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City | DIAMOND BAR
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State | CA
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Zip | 91765-3481
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Country | US
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Telephone | 909-594-6469
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Fax | 909-348-8166
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Provider Business Mailing Address
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Address Line | PO BOX 4554
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City | DIAMOND BAR
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State | CA
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Zip | 91765-0554
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Country | US
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Telephone | 909-594-6469
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Fax | 909-348-8166
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KITTY WEN
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Credential |
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Telephone | 909-525-5647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | LC20080000366
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License Number State | CA
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