MEDICARE: DINEURO DIAGNOSTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1285994764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DINEURO DIAGNOSTIC

Provider Business Mailing Address
First Line	:	13896 HARBOR BLVD
Second Line	:	SUITE 5C
City	:	GARDEN GROVE
State	:	CA
Zip	:	93843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13896 HARBOR BLVD
Second Line	:	SUITE 5C
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-4045
Country	:	US
Telephone Number	:	714-554-2222
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SIROUS SORAT
Credential	:
Telephone Number	:	714-554-2222

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	05/18/2012

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Directions to “DINEURO DIAGNOSTIC ” Practice Location

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