1407030042 NPI number — ELIAS RADIOLOGY ASSOCIATES PA

Table of content: VALERIE MARIE MUNIZ (NPI 1447738612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407030042 NPI number — ELIAS RADIOLOGY ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIAS RADIOLOGY ASSOCIATES PA
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:
1407030042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10420 SW 77 AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PINECREST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-3771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-661-1720
Provider Business Mailing Address Fax Number:
305-661-1652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10420 SW 77TH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PINECREST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33156-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-661-1720
Provider Business Practice Location Address Fax Number:
305-661-1652
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELIAS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
SETH
Authorized Official Title or Position:
MEDICAL PROVIDER
Authorized Official Telephone Number:
305-661-1720

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME37821 , 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)

  • Identifier: ME37821 . This is a "LIC NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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