Source Diagnostics West LLC
Organization Active NPI Portable X-ray and/or Other Portable Diagnostic Imaging Supplier · LQ, CA
NPI 1598063133 · NPPES record last updated May 18, 2011
Key facts
- NPI
- 1598063133
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X
- License
- 00080313 (CA)
- Legal business name
- SOURCE DIAGNOSTICS WEST LLC
- Practice address
- 49440 Via Pompa
LQ, CA 92253 - Phone
- (760) 777-4352
- NPI assigned
- Mar 7, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Paul J Mezacapa, RT. (R) MR, CT
- Title
- Managing Member
- Phone
- (760) 777-4352
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sonography Specialist/Technologist Cardiovascular |
246XS1301X | |||
| Sonography Radiologic Technologist |
2471S1302X | |||
| Vascular Sonography Radiologic Technologist |
2471V0105X | |||
| Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 335V00000X | 00080313 | CA | Yes |
Addresses
Primary practice location
49440 Via Pompa
LQ, CA 92253
Mailing address
49440 Via Pompa
La Quinta, CA 92253
Phone (760) 777-4352
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.