Healthcare Provider Details

I. General information

NPI: 1083802870
Provider Name (Legal Business Name): WEST DIAGNOSTIC MEDICAL IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 W 68TH ST
HIALEAH FL
33016-1876
US

IV. Provider business mailing address

6700 N ANDREWS AVE 109
FORT LAUDERDALE FL
33309-2165
US

V. Phone/Fax

Practice location:
  • Phone: 186-659-5529
  • Fax: 954-636-5428
Mailing address:
  • Phone: 954-636-3406
  • Fax: 954-636-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. SOLANGIE MACHADO
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-636-3406