Organization
INTEGRATED MANAGEMENT & DIAGNOSTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE WILDISH (CFO)
(951) 368-0428
Entity
Organization
Contact information
Practice address
5790 MAGNOLIA AVE, SUITE 201, RIVERSIDE, CA 92506-1874
(951) 368-0428
(951) 378-0429
Mailing address
5790 MAGNOLIA AVE, SUITE 201, RIVERSIDE, CA 92506-1874
(951) 368-0428
(951) 378-0429
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
293D00000X
Physiological Laboratory
—
—
Other
Enumeration date
01/29/2013
Last updated
01/29/2013
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