# INTEGRATIVE DIAGNOSTIC GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** INTEGRATIVE DIAGNOSTIC GROUP INC
- **Other names:** INTEGRATIVE DIAGNOSTIC GROUP INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104373745
- **Legal business name:** INTEGRATIVE DIAGNOSTIC GROUP INC
- **Authorized official:** MR. ANIL K GANGHI MD. (PRESIDENT)
- **Authorized official phone:** (562) 653-0180

## Contact information

- **Practice address:** 12231 ARTESIA BLVD, CERRITOS, CA 90703-2750
- **Practice address phone:** (562) 653-0180
- **Practice address fax:** (562) 402-3029
- **Mailing address:** 1231 ARTESIA BLVD, CERRITOS, CA 90703-2750
- **Mailing address phone:** (562) 653-0180
- **Mailing address fax:** (562) 402-3029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | A30411 | CA | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | PSY6247 | CA | — |

## Other

- **Enumeration date:** 09/01/2016
- **Last updated:** 09/01/2016