Healthcare Provider Details

I. General information

NPI: 1114535762
Provider Name (Legal Business Name): CORAL HILLS IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9690 W SAMPLE RD STE 103
CORAL SPRINGS FL
33065-4031
US

IV. Provider business mailing address

9690 W SAMPLE RD STE 103
CORAL SPRINGS FL
33065-4031
US

V. Phone/Fax

Practice location:
  • Phone: 954-346-8800
  • Fax: 954-346-8280
Mailing address:
  • Phone: 954-346-8800
  • Fax: 954-346-8280

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. LUIS F GUTIERREZ
Title or Position: OWNER
Credential: MD
Phone: 954-410-8646