National Provider Identifier Database

INNOVATIVE DIAGNOSTIC MEDICAL GROUP
Physiological Laboratory, (Independent Physiological Lab)

A laboratory that operates independently of a hospital and physician?s office to furnish physiological diagnostic services (e.g. EEG?s , EKG?s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services.


Contact Information

INNOVATIVE DIAGNOSTIC MEDICAL GROUP
1801 CENTURY PARK EAST
SUITE 1040
LOS ANGELES, CA90067
Phone: 310-553-7980
Fax: 310-943-3279
Website:
Specialty Taxonomy Code
* Physiological Laboratory, (Independent Physiological Lab) 293D00000X
Physical Medicine & Rehabilitation 208100000X

* Indicates primary specialty

NPI Profile & details for INNOVATIVE DIAGNOSTIC MEDICAL GROUP

NPI Number 1013131796
Legal business name
LBN
INNOVATIVE DIAGNOSTIC MEDICAL GROUP
Authorized official SEAN ATAEE - (MEDICAL DIRECTOR/OWNER)
Entity Organization
Organization subpart No
Enumeration date 04/12/2007
Last updated 12/16/2010 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • CA License #: A106704
  • CA License #: A44107

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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