Provider Demographics
NPI:1316277825
Name:G&H DIAGNOSTIC, INC.
Entity type:Organization
Organization Name:G&H DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-576-6248
Mailing Address - Street 1:1150 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3668
Mailing Address - Country:US
Mailing Address - Phone:909-576-6248
Mailing Address - Fax:
Practice Address - Street 1:1150 N MOUNTAIN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3668
Practice Address - Country:US
Practice Address - Phone:909-576-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center