MEDICARE: L G DIAGNOSTIC 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	261QR1100X	Research Clinic/Center	HCC4353	FL

General Provider Information

NPI Number	:	1639110042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L G DIAGNOSTIC INC

Provider Business Mailing Address
First Line	:	689 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	689 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4523
Country	:	US
Telephone Number	:	305-884-3233
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDUARDO GUERRA
Credential	:
Telephone Number	:	305-884-3233

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/22/2020

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