Provider Demographics
NPI:1487943007
Name:APEX DIAGNOSTIC SERVICES, INC.
Entity type:Organization
Organization Name:APEX DIAGNOSTIC SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-379-5100
Mailing Address - Street 1:14600 GOLDENWEST ST
Mailing Address - Street 2:SUITE A103
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5201
Mailing Address - Country:US
Mailing Address - Phone:714-379-5100
Mailing Address - Fax:949-610-0223
Practice Address - Street 1:14600 GOLDENWEST ST
Practice Address - Street 2:SUITE A103
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5201
Practice Address - Country:US
Practice Address - Phone:714-379-5100
Practice Address - Fax:949-610-0223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APEX DIAGNOSTIC SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-05
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50159207RC0000X
CA00070394246XS1301X
CAARDMS#1161742471V0105X
CA000701342471C1106X
CAG558562084D0003X, 2084N0400X
CAG764992085R0202X, 2085U0001X
CAARDMS#1368672471C1106X
CAARDMS#1388332471S1302X
CAAAET#671246ZE0600X
CAARDMS#109990246ZE0600X
CAAAET#6692471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
No2471C1106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiac-Interventional TechnologyGroup - Multi-Specialty
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT30033315OtherNEWPORT BEACH BUSINESS LICENSE