Healthcare Provider Details

I. General information

NPI: 1558501569
Provider Name (Legal Business Name): VIRTUAL IMAGING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 PALM AVE
HIALEAH FL
33012-5241
US

IV. Provider business mailing address

7101 SW 99TH AVE SUITE 106
MIAMI FL
33173-4661
US

V. Phone/Fax

Practice location:
  • Phone: 305-863-1755
  • Fax:
Mailing address:
  • Phone: 305-596-9992
  • Fax: 305-596-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberHCC8443
License Number StateFL

VIII. Authorized Official

Name: MR. JUAN PUIG
Title or Position: PRESIDENT
Credential:
Phone: 305-596-9992