Healthcare Provider Details

I. General information

NPI: 1972632321
Provider Name (Legal Business Name): MEDICUS DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD N SUITE 116
BOCA RATON FL
33428-1762
US

IV. Provider business mailing address

9980 CENTRAL PARK BLVD N SUITE 116
BOCA RATON FL
33428-1762
US

V. Phone/Fax

Practice location:
  • Phone: 561-893-0651
  • Fax: 561-893-0655
Mailing address:
  • Phone: 561-893-0651
  • Fax: 561-893-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FERNANDO M LOPEZ-IVERN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-893-0651