# SOURCE DIAGNOSTICS WEST LLC

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

## Provider details

- **NPI number:** 1598063133
- **Authorized official:** MR. PAUL J MEZACAPA RT. (R) MR, CT (MANAGING MEMBER)
- **Authorized official phone:** (760) 777-4352

## Contact information

- **Practice address:** 49440 VIA POMPA, LQ, CA 92253
- **Practice address phone:** (760) 777-4352
- **Mailing address:** 49440 VIA POMPA, LA QUINTA, CA 92253
- **Mailing address phone:** (760) 777-4352

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246XS1301X | Sonography Specialist/Technologist Cardiovascular | — | NULL | — |
| 246XS1301X | Sonography Specialist/Technologist Cardiovascular | — | — | — |
| 2471S1302X | Sonography Radiologic Technologist | — | NULL | — |
| 2471S1302X | Sonography Radiologic Technologist | — | — | — |
| 2471V0105X | Vascular Sonography Radiologic Technologist | — | NULL | — |
| 2471V0105X | Vascular Sonography Radiologic Technologist | — | — | — |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 00080313 | CA | Yes |

## Other

- **Enumeration date:** 03/07/2011
- **Last updated:** 05/18/2011