1811093131 NPI number — BERNARDINO ORESTES ENRIQUEZ GENERAL RADIOGRAPHER

Table of content: BERNARDINO ORESTES ENRIQUEZ GENERAL RADIOGRAPHER (NPI 1811093131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811093131 NPI number — BERNARDINO ORESTES ENRIQUEZ GENERAL RADIOGRAPHER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENRIQUEZ
Provider First Name:
BERNARDINO
Provider Middle Name:
ORESTES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
GENERAL RADIOGRAPHER
Provider Gender Code:
M

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:
1811093131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12240 NW 7TH TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33182-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-505-3619
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 S HOSPITAL DR STE 206
Provider Second Line Business Practice Location Address:
PLANTATION
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-321-3638
Provider Business Practice Location Address Fax Number:
954-321-1422
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2471C3402X , with the licence number:  38641 , 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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