Healthcare Provider Details

I. General information

NPI: 1770903007
Provider Name (Legal Business Name): IMAGEN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8181 NW 36TH ST STE 5B
DORAL FL
33166-6628
US

IV. Provider business mailing address

8181 NW 36TH ST STE 5B
DORAL FL
33166-6628
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-7167
  • Fax: 786-953-6871
Mailing address:
  • Phone: 786-558-7167
  • Fax: 786-953-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA66664
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: ARLEX DIAZ
Title or Position: PRESIDENT
Credential:
Phone: 786-558-7167