# INDEPENDENT DIAGNOSTIC TESTING INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124342373
- **Authorized official:** MR. FRED E SUFFICOOL PARAMEDIC (CEO)
- **Authorized official phone:** (619) 461-0039

## Contact information

- **Practice address:** 7877 PARKWAY DR, LA MESA, CA 91942-2000
- **Practice address phone:** (619) 461-0039
- **Practice address fax:** (619) 461-5941
- **Mailing address:** 7877 PARKWAY DR, LA MESA, CA 91942-2000
- **Mailing address phone:** (619) 461-0039
- **Mailing address fax:** (619) 461-5941

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 335V00000X | CA | Yes |

## Other

- **Enumeration date:** 03/17/2010
- **Last updated:** 03/17/2010