INTEGRATIVE DIAGNOSTIC GROUP INC


Address: 12231 Artesia Blvd, Cerritos, CA 90703-2750
Phone: 5626530180

INTEGRATIVE DIAGNOSTIC GROUP INC (NPI# 1104373745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104373745
Entity Type Organization
Organization Name INTEGRATIVE DIAGNOSTIC GROUP INC
Other Organization Name INTEGRATIVE DIAGNOSTIC GROUP INC
Practice Address 12231 Artesia Blvd
Cerritos
CA 90703-2750
Mailing Address 1231 Artesia Blvd
Cerritos
CA 90703-2750
Practice Telephone 5626530180
Practice Fax Number 5624023029
Mailing Telephone 5626530180
Mailing Fax Number 5624023029
Enumeration Date 2016-09-01
Last Update Date 2016-09-01
Authorized Official Name MR. ANIL K GANGHI (PRESIDENT)
Authorized Official Telephone 5626530180
Authorized Official Credential MD.
Is Organization Subpart Y
Parent Organization Name INTEGRATIVE DIAGNOSTIC GROUP INC

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 323P00000X Psychiatric Residential Treatment Facility PSY6247 CA Residential Treatment Facilities
Y 207QA0505X Family Medicine
Specialization: Adult Medicine
A30411 CA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CA 1972824753 05

Other Provider/Organization Names

Other Name Type Code
INTEGRATIVE DIAGNOSTIC GROUP INC Other Name - Individual/Organization

Office Location

Street Address 12231 ARTESIA BLVD
City CERRITOS
State CA
Zip Code 90703-2750

Providers in the same zip code

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1841843554 Ha Tran Tsai Dental Corporation Dentist 16466 Norwalk Boulevard, Cerritos, CA 90703 2019-07-22
1457828097 Angela Ofoegbu Registered Nurse 10733 Elgers St, Cerritos, CA 90703 2018-11-01
1689183352 Zeela G Diwa Occupational Therapist 12736 Palm Street, Cerritos, CA 90703 2017-09-26
1114446119 Cooper Lee Physical Therapist 18503 Noran Ave, Cerritos, CA 90703 2017-09-12
1295259141 Miyeon Vivienne Lee Nurse Practitioner 13337 South Street #158, Cerritos, CA 90703 2017-08-02
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Taxonomy Information

Taxonomy Code 207QA0505X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Adult Medicine

Taxonomy Definition

Definition to come.

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Competitor

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City CERRITOS
Zip Code 90703

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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