Healthcare Provider Details

I. General information

NPI: 1962444778
Provider Name (Legal Business Name): ELITE IMAGING HIALEAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST
HIALEAH FL
33012-3435
US

IV. Provider business mailing address

PO BOX 802031
AVENTURA FL
33280-2031
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-6622
  • Fax:
Mailing address:
  • Phone: 305-558-6622
  • Fax: 305-558-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number6822
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number6822
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number6822
License Number StateFL

VIII. Authorized Official

Name: GERMAINE RODRIGUEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 786-553-4510