Doug Allen Gustafson, ARDMS,RVT,RDCS

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Practice address

34724 Caprock Rd
Agua Dulce, CA 91390-5422

Phone

(661) 268-0791

Fax

(661) 268-0792

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cardiac Imaging Services, Inc.

  • Physiological Laboratory
  • Agua Dulce, CA
  • NPI 1437323326
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760592984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34724 CAPROCK RD",
            "city": "AGUA DULCE",
            "state": "CA",
            "postal_code": "913905422",
            "telephone_number": "661-268-0791",
            "fax_number": "661-268-0792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34724 CAPROCK RD",
            "city": "AGUA DULCE",
            "state": "CA",
            "postal_code": "913905422",
            "telephone_number": "661-268-0791",
            "fax_number": "661-268-0792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "DOUG",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "ARDMS,RVT,RDCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cardiac Imaging Services, Inc.
• Judith Mary Dalton, R.D.
• Vivian Sheila Dungan
• Sophie Forbes-Johnson, MS
• Curtis Lee Garrick, D.C.
• Nebo Hill Treatment Center
• Jonathan Pascual Rosales
• Senior Home Care la
• Debra Kay Smith, LMFT
• Cynthia Nicole Valdez

• Physiological Laboratory in Agua Dulce, CA
• Providers in Agua Dulce, CA by specialty
• Physiological Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.