Provider Demographics
NPI:1538366570
Name:MAR DIAGNOSTIC SERVICE, INC
Entity type:Organization
Organization Name:MAR DIAGNOSTIC SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-990-1411
Mailing Address - Street 1:14659 TITUS ST
Mailing Address - Street 2:STE.C
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4940
Mailing Address - Country:US
Mailing Address - Phone:818-989-9848
Mailing Address - Fax:
Practice Address - Street 1:14659 TITUS ST
Practice Address - Street 2:STE.C
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4940
Practice Address - Country:US
Practice Address - Phone:818-989-9848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID