Healthcare Provider Details

I. General information

NPI: 1336236363
Provider Name (Legal Business Name): CORAL GABLES MRI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 PONCE DE LEON BLVD
CORAL GABLES FL
33134-2075
US

IV. Provider business mailing address

PO BOX 440546
MIAMI FL
33144-0546
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 TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

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