1760627533 NPI number — PAN AM DIAGNOSTIC SERVICES, INC.

Table of content: AVNI SHETH (NPI 1730765140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760627533 NPI number — PAN AM DIAGNOSTIC SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAN AM DIAGNOSTIC SERVICES, 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:
6
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:
1760627533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 W 45TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-3126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-773-1403
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6421 MILNER BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32809-6669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-857-1700
Provider Business Practice Location Address Fax Number:
407-857-1600
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KAHANA
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
305-773-1403

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  HCC7181 , 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)





Copyright © 2007-2025 www.npivalidator.com