Basic Information
| Provider Information | |||||||||
| NPI: | 1245427871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HI DIAGNOSTIC IMAGING GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 318 W COLORADO ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912041670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182425588 | ||||||||
| FaxNumber: | 8182423730 | ||||||||
| Practice Location | |||||||||
| Address1: | 318 W COLORADO ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912041670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182425588 | ||||||||
| FaxNumber: | 8182423730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | TAFAZOLI | ||||||||
| AuthorizedOfficialFirstName: | MANSOUR | ||||||||
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| AuthorizedOfficialTitleorPosition: | RADIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8182425588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | A46577 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.