MEDICARE: VIVAX-RAY MEDICAL DIAGNOSTIC CENTER, 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	261QH0100X	Health Service Clinic/Center	HCC7919	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821259169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVAX-RAY MEDICAL DIAGNOSTIC CENTER, INC

Provider Business Mailing Address
First Line	:	3750 W 16TH AVE
Second Line	:	STE 136U
City	:	HIALEAH
State	:	FL
Zip	:	33012-4654
Country	:	US
Telephone Number	:	305-825-1418
Fax Number	:	305-825-1419

Provider Business Practice Location Address
First Line	:	3750 W 16TH AVE STE 204
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4648
Country	:	US
Telephone Number	:	305-825-1418
Fax Number	:	305-825-1419

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSMIN VIVAS
Credential	:	R.T(R)
Telephone Number	:	305-825-1418

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	04/21/2025

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