Organization
CLINICAL DIAGNOSTIC RADIOLOGY IN NUCLEAR MEDICINE
Active
Organization
CLINICAL DIAGNOSTIC RADIOLOGY IN NUCLEAR MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID COHEN (PRESIDENT MANAGING MEMBER)
(818) 879-9600
Entity
Organization
Contact information
Practice address
7600 N 15TH ST STE 102, PHOENIX, AZ 85020-4330
(805) 577-2167
Mailing address
PO BOX 53300, PHOENIX, AZ 85072-3300
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474031
—
AZ
01
—
AZ0047590
BCBSAZ
—
Enumeration date
12/06/2006
Last updated
08/17/2007
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