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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