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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 Specialty Code Provider Type

Physiological Laboratory, (Independent Physiological Lab)

293D00000X 47 Independent Diagnostic Testing Facility (IDTF)
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for INNOVATIVE DIAGNOSTIC MEDICAL GROUP

NPI Number 1013131796
LBN Legal business name INNOVATIVE DIAGNOSTIC MEDICAL GROUP
Authorized official SEAN ATAEE - (MEDICAL DIRECTOR/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/12/2007
Last updated 12/16/2010 - About 15 years ago
Identifiers
CA License # A106704
CA License # A44107
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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