Organization
CALIFORNIA DIAGNOSTIC IMAGING CENTER A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J UNDERWOOD MD (PRESIDENT)
(626) 339-5464
Entity
Organization
Contact information
Practice address
828 S GRAND AVE, STE 104, GLENDORA, CA 91740-4856
(626) 915-5181
(626) 331-2313
Mailing address
BOX 5010, GLENDORA, CA 91740-0735
(626) 915-5181
(626) 331-2313
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0103720
—
CA
01
—
P00081546
RAIL ROAD MEDICARE GRP #
CA
01
—
ZZZ07258Z
BLUE SHIELD
CA
Enumeration date
08/16/2005
Last updated
10/18/2017
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