Provider Demographics
NPI:1992885263
Name:XDI ULTRASOUND
Entity type:Organization
Organization Name:XDI ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:619-546-8005
Mailing Address - Street 1:1915 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1210
Mailing Address - Country:US
Mailing Address - Phone:619-546-8005
Mailing Address - Fax:619-546-8007
Practice Address - Street 1:1915 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1210
Practice Address - Country:US
Practice Address - Phone:619-546-8005
Practice Address - Fax:619-546-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG105Medicare ID - Type UnspecifiedMEDICARE NUMBER