Healthcare Provider Details

I. General information

NPI: 1154169613
Provider Name (Legal Business Name): REMOTE RAD TECH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 THE GRN
DOVER DE
19901-3618
US

IV. Provider business mailing address

9100 S DADELAND BLVD STE 1500
MIAMI FL
33156-7816
US

V. Phone/Fax

Practice location:
  • Phone: 646-785-0788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FLAVIO CIPRIANO DA FONSECA LANES
Title or Position: MANAGER
Credential:
Phone: 646-785-0788