Healthcare Provider Details

I. General information

NPI: 1811945884
Provider Name (Legal Business Name): R I S MOBILE DIAGNOSTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21561 SW 94TH AVE
CUTLER BAY FL
33189-3747
US

IV. Provider business mailing address

21561 SW 94TH AVE
CUTLER BAY FL
33189-3747
US

V. Phone/Fax

Practice location:
  • Phone: 305-255-8777
  • Fax: 305-255-8713
Mailing address:
  • Phone: 305-255-8777
  • Fax: 305-255-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN A VAZQUEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-255-8777