Healthcare Provider Details

I. General information

NPI: 1407957434
Provider Name (Legal Business Name): AMBULATORY DIAGNOSTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 PONCE DE LEON BLVD FIRST FLOOR
CORAL GABLES FL
33134-2049
US

IV. Provider business mailing address

747 PONCE DE LEON BLVD FIRST FLOOR
CORAL GABLES FL
33134-2049
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-7893
  • Fax: 305-442-1183
Mailing address:
  • Phone: 305-446-7893
  • Fax: 305-442-1183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILFRED BRACERAS
Title or Position: PRESIDENT
Credential:
Phone: 305-863-8860