Healthcare Provider Details

I. General information

NPI: 1467929364
Provider Name (Legal Business Name): VITAL IMAGING DIAGNOSTIC CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3146 CORAL WAY
CORAL GABLES FL
33145-3210
US

IV. Provider business mailing address

7101 SW 99TH AVE
MIAMI FL
33173-4661
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-6999
  • Fax:
Mailing address:
  • Phone: 305-596-9992
  • Fax:

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: JUAN PUIG
Title or Position: MGRM
Credential:
Phone: 305-596-9992