Basic Information
| Provider Information | |||||||||
| NPI: | 1467764597 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH DIAGNOSTICS OF DALY CITY, LLC | ||||||||
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| OtherOrganizationName: | HEALTH DIAGNOSTICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 MARINA VILLAGE PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945011087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108659670 | ||||||||
| FaxNumber: | 5102179708 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 HICKEY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940152629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507572030 | ||||||||
| FaxNumber: | 6507572036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 07/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | HUMMEL | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5108659670 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.