Organization
SOLMAZ MODEER
Active
Parent organization
WESTERN DIAGNOSTIC IMAGING CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN DIAGNOSTIC IMAGING CENTER
Authorized official
SOLMAZ MODEER RT, RTM (OWNER/DIRECTOR)
(619) 409-6939
Entity
Organization
Contact information
Practice address
1635 3RD AVE STE G, CHULA VISTA, CA 91911-5884
(619) 409-6939
(619) 409-6949
Mailing address
14795 CAMINITO ORENSE ESTE, SAN DIEGO, SAN DIEGO, CA 92129-1532
(619) 409-6939
(619) 409-6949
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
TG145
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTF00430
—
CA
Enumeration date
04/01/2008
Last updated
11/16/2011
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