Organization
INTEGRATIVE DIAGNOSTIC GROUP INC
Active
Parent organization
INTEGRATIVE DIAGNOSTIC GROUP INC
Other names
INTEGRATIVE DIAGNOSTIC GROUP INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTEGRATIVE DIAGNOSTIC GROUP INC
Authorized official
MR. ANIL K GANGHI MD. (PRESIDENT)
(562) 653-0180
Entity
Organization
Contact information
Practice address
12231 ARTESIA BLVD, CERRITOS, CA 90703-2750
(562) 653-0180
(562) 402-3029
Mailing address
1231 ARTESIA BLVD, CERRITOS, CA 90703-2750
(562) 653-0180
(562) 402-3029
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
A30411
CA
323P00000X
Psychiatric Residential Treatment Facility
PSY6247
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972824753
—
CA
Enumeration date
09/01/2016
Last updated
09/01/2016
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