MEDICARE: FLORIDA MEDICAL DIAGNOSTIC IMAGING, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician

General Provider Information

NPI Number	:	1417939646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEDICAL DIAGNOSTIC IMAGING, INC

Provider Business Mailing Address
First Line	:	PO BOX 821103
Second Line	:
City	:	SOUTH FLORIDA
State	:	FL
Zip	:	33082-1103
Country	:	US
Telephone Number	:	954-450-1885
Fax Number	:	954-430-0214

Provider Business Practice Location Address
First Line	:	5200 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2706
Country	:	US
Telephone Number	:	954-450-1885
Fax Number	:	954-430-0214

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. FERNANDO PINZON
Credential	:
Telephone Number	:	954-450-1885

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	08/22/2020

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