Basic Information
| Provider Information | |||||||||
| NPI: | 1255546198 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST CHOICE DIAGNOSTIC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 556 S FAIR OAKS AVE | ||||||||
| Address2: | SUITE 357 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842865 | ||||||||
| FaxNumber: | 9094847257 | ||||||||
| Practice Location | |||||||||
| Address1: | 556 S. FAIR OAKS AVE | ||||||||
| Address2: | SUITE 357 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094842865 | ||||||||
| FaxNumber: | 9094847257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DEVORA | ||||||||
| AuthorizedOfficialFirstName: | FLORENCIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 9094842865 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Contractor |
No ID Information.