Basic Information
| Provider Information | |||||||||
| NPI: | 1215903158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCAFIDI | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT LA 21693 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911851693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585641400 | ||||||||
| FaxNumber: | 8585641500 | ||||||||
| Practice Location | |||||||||
| Address1: | 36320 INLAND VALLEY DR | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WILDOMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925957512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516003811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G80079 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00G800790 | 05 | CA | MEDICAID | 00G800790 | 01 | CA | BCBS | OTHER |