Healthcare Provider Details

I. General information

NPI: 1023448529
Provider Name (Legal Business Name): MOVIL DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11320 NW 62ND AVE
HIALEAH FL
33012-2362
US

IV. Provider business mailing address

11320 NW 62ND AVE
HIALEAH FL
33012-2362
US

V. Phone/Fax

Practice location:
  • Phone: 786-615-9386
  • Fax:
Mailing address:
  • Phone: 786-615-9386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ODALIS MONDEJA
Title or Position: PRESIDENT
Credential:
Phone: 786-615-9386