1821136623 NPI number — MIA DIAGNOSTICS OF SOUTH FLORIDA CORP

Table of content: (NPI 1821136623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821136623 NPI number — MIA DIAGNOSTICS OF SOUTH FLORIDA CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIA DIAGNOSTICS OF SOUTH FLORIDA CORP
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:
1821136623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9745 SW 72ND ST
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-4652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-630-9252
Provider Business Mailing Address Fax Number:
305-630-9241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9745 SW 72ND ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-4652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-630-9252
Provider Business Practice Location Address Fax Number:
305-630-9241
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARDO
Authorized Official First Name:
RAUL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-262-6143

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HCC7500 . This is a "HCC LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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