1164608006 NPI number — PRECISION IMAGING & DIAGNOSTIC CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164608006 NPI number — PRECISION IMAGING & DIAGNOSTIC CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION IMAGING & DIAGNOSTIC CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164608006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 SW 27TH AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33145-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-447-2324
Provider Business Mailing Address Fax Number:
305-447-2358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 SW 27TH AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33145-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-447-2324
Provider Business Practice Location Address Fax Number:
305-447-2358
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
PAVEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-447-2324

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC 7961 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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