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Organization
MEDICAL DIAGNOSTIC
Active
Organization
MEDICAL DIAGNOSTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA FERNANDEZ (ADMINISTRATOR)
(323) 581-4195
Entity
Organization
Contact information
Practice address
2736 E FLORENCE AVE, HUNTINGTON PARK, CA 90255-5747
(323) 581-4195
Mailing address
2736 E FLORENCE AVE, HUNTINGTON PARK, CA 90255-5747
(323) 581-4195
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
G23748
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DIAA00080
MEDI-CAL
CA
Enumeration date
05/03/2007
Last updated
08/22/2020
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