Healthcare Provider Details

I. General information

NPI: 1477607117
Provider Name (Legal Business Name): WOMENS DIAGNOSTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 OAKFIELD DR
BRANDON FL
33511-4841
US

IV. Provider business mailing address

1357 OAKFIELD DR
BRANDON FL
33511-4841
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-5144
  • Fax: 813-684-5084
Mailing address:
  • Phone: 813-684-5144
  • Fax: 813-684-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number161638
License Number StateFL

VIII. Authorized Official

Name: MR. ABDULLAH GHAEDI
Title or Position: VICE PRESIDENT
Credential:
Phone: 813-684-5144