| Integrative Diagnostic Group Inc | |
|
12231 Artesia Blvd Cerritos CA 90703-2750 | |
| (562) 653-0180 | |
| (562) 402-3029 |
| Full Name | Integrative Diagnostic Group Inc |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 12231 Artesia Blvd, Cerritos, California |
| Authorized Official Name and Position | Anil K Ganghi (PRESIDENT) |
| Authorized Official Contact | 5626530180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Diagnostic Group Inc 1231 Artesia Blvd Cerritos CA 90703-2750 Ph: (562) 653-0180 | Integrative Diagnostic Group Inc 12231 Artesia Blvd Cerritos CA 90703-2750 Ph: (562) 653-0180 |
| NPI Number | 1104373745 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 09/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104373745 | NPI | - | NPPES |
| 1972824753 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | A30411 (California) | Primary |
| 323P00000X | Psychiatric Residential Treatment Facility | PSY6247 (California) | Secondary |
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