Healthcare Provider Details

I. General information

NPI: 1871822239
Provider Name (Legal Business Name): CARDIO IMAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W CENTRAL PKWY SUITE 2000
ALTAMONTE SPRINGS FL
32714-2436
US

IV. Provider business mailing address

450 W CENTRAL PKWY SUITE 2000
ALTAMONTE SPRINGS FL
32714-2436
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-8554
  • Fax: 407-767-9121
Mailing address:
  • Phone: 407-767-8554
  • Fax: 407-767-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberME84848
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberME84848
License Number StateFL

VIII. Authorized Official

Name: BABAK A VAKILI
Title or Position: PRESIDENT
Credential: MD
Phone: 407-767-8554