Organization
ONE SOURCE DIAGNOSTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSA DIAZ PADILLA (MANAGING DIRECTOR)
(702) 568-0007
Entity
Organization
Contact information
Practice address
11 W PACIFIC AVE, HENDERSON, NV 89015-7304
(702) 568-6433
(702) 568-6299
Mailing address
11 W PACIFIC AVE, HENDERSON, NV 89015-7304
(702) 568-6433
(702) 568-6299
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
1003036295
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003036295
NV STATE BUSINESS LICENSE
NV
Enumeration date
06/17/2006
Last updated
08/22/2020
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