Healthcare Provider Details

I. General information

NPI: 1154781771
Provider Name (Legal Business Name): VSI RAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W 49TH PL
HIALEAH FL
33012-3113
US

IV. Provider business mailing address

5927 SW 70TH #439031
MIAMI FL
33143-9998
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-2500
  • Fax: 305-666-1065
Mailing address:
  • Phone: 305-666-2427
  • Fax: 305-666-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OSMANY DEANGELO
Title or Position: MEDICAL DIRECTOR
Credential: D.O
Phone: 305-598-1555