MEDICARE: HEALTH DIAGNOSTICS OF CALIFORNIA LLC

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	261QR0200X	Radiology Clinic/Center	040095	CA

General Provider Information

NPI Number	:	1699706648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH DIAGNOSTICS OF CALIFORNIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 5651
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-5651
Country	:	US
Telephone Number	:	714-571-5000
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	4144 REDWOOD HWY
Second Line	:	SUITE B
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2646
Country	:	US
Telephone Number	:	415-479-9907
Fax Number	:	415-479-9908

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOWARD J. SIMON
Credential	:	M.D.
Telephone Number	:	480-264-2400

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/20/2011

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