Healthcare Provider Details

I. General information

NPI: 1346655909
Provider Name (Legal Business Name): DIAGNOSTIC & SLEEP CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE SUITE 591
DORAL FL
33166-6556
US

IV. Provider business mailing address

3900 NW 79TH AVE SUITE 591
DORAL FL
33166-6556
US

V. Phone/Fax

Practice location:
  • Phone: 305-436-0206
  • Fax: 305-397-2527
Mailing address:
  • Phone: 305-436-0206
  • Fax: 305-397-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberME93401
License Number StateFL

VIII. Authorized Official

Name: FERNANDO E BAYRON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-397-2527